Healthcare Provider Details

I. General information

NPI: 1285648469
Provider Name (Legal Business Name): STEPHANIE S DEBUCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 BRENTWOOD, SUITE A ORTHOPEDIC SERVICES OF CMA
ITHACA NY
14850
US

IV. Provider business mailing address

16 BRENTWOOD, SUITE A ORTHOPEDIC SERVICES OF CMA
ITHACA NY
14850
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-7000
  • Fax: 607-272-4604
Mailing address:
  • Phone: 607-272-7000
  • Fax: 607-272-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number209083
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number209083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: