Healthcare Provider Details

I. General information

NPI: 1316950199
Provider Name (Legal Business Name): DEBORAH N RISBROOK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1433
US

IV. Provider business mailing address

175 COMMUNITY DR
GREAT NECK NY
11021-5502
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7396
  • Fax: 718-470-9402
Mailing address:
  • Phone: 516-465-1900
  • Fax: 516-465-1830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberF333236 / 431078
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: