Healthcare Provider Details

I. General information

NPI: 1629264205
Provider Name (Legal Business Name): DEBADON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 EDGMONT AVE
BROOKHAVEN PA
19015-3316
US

IV. Provider business mailing address

2711 EDGMONT AVE
BROOKHAVEN PA
19015-3316
US

V. Phone/Fax

Practice location:
  • Phone: 610-876-4935
  • Fax: 610-876-5940
Mailing address:
  • Phone: 610-876-4935
  • Fax: 610-876-5940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License NumberD00914
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number6000007099
License Number StatePA

VIII. Authorized Official

Name: MR. DONALD BRUCE ASPLEN
Title or Position: OWNER
Credential:
Phone: 610-876-4935