Healthcare Provider Details

I. General information

NPI: 1760577258
Provider Name (Legal Business Name): DEBRA J WERNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/09/2024
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 NEW DORP LN STE 2
STATEN ISLAND NY
10306-2314
US

IV. Provider business mailing address

83 WESTMINSTER CT
STATEN ISLAND NY
10304-1313
US

V. Phone/Fax

Practice location:
  • Phone: 718-668-1700
  • Fax: 718-668-1733
Mailing address:
  • Phone: 718-668-1700
  • Fax: 718-668-1733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number185682
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: