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General NPI Number Information
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NPI Number | 1326542077
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Entity Type | Individual
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Provider Name | DEBRA PETROVER DO
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Gender | Female
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 08/15/2023
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Provider Practice Location Address
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Address Line | 1771 MADISON AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1242
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Country | US
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Telephone | 732-364-2144
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Fax |
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Provider Business Mailing Address
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Address Line | 1771 MADISON AVE
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City | LAKEWOOD
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State | NJ
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Zip | 08701-1242
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Country | US
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Telephone | 732-364-2144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 310189
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 25MB11915900
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License Number State | NJ
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