Healthcare Provider Details

I. General information

NPI: 1497152607
Provider Name (Legal Business Name): DEBRA ORESTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 N OCEAN AVE SUITE 2
PATCHOGUE NY
11772-2016
US

IV. Provider business mailing address

157 N OCEAN AVE SUITE 2
PATCHOGUE NY
11772-2016
US

V. Phone/Fax

Practice location:
  • Phone: 631-475-6444
  • Fax: 631-475-6941
Mailing address:
  • Phone: 631-475-6444
  • Fax: 631-475-6941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number046643
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: