Provider Demographics
NPI:1043588841
Name:FALLENBERG, DEBORAH MAE (RN)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MAE
Last Name:FALLENBERG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 OLDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1235
Mailing Address - Country:US
Mailing Address - Phone:631-754-5310
Mailing Address - Fax:631-651-2092
Practice Address - Street 1:2 OLDFIELD RD
Practice Address - Street 2:
Practice Address - City:GREENLAWN
Practice Address - State:NY
Practice Address - Zip Code:11740-1235
Practice Address - Country:US
Practice Address - Phone:631-754-5310
Practice Address - Fax:631-651-2092
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242081-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse