Healthcare Provider Details

I. General information

NPI: 1912262437
Provider Name (Legal Business Name): DEBORAH JUE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH NAUTSCH MD

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 GUION PL DEPARTMENT OF PATHOLOGY
NEW ROCHELLE NY
10801-5502
US

IV. Provider business mailing address

16 GUION PLACE DEPARTMENT OF PATHOLOGY
NEW ROCHELLE NY
10801-5502
US

V. Phone/Fax

Practice location:
  • Phone: 914-365-3671
  • Fax:
Mailing address:
  • Phone: 914-365-3671
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD60634630
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number290518-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: