Provider Demographics
NPI:1447299748
Name:MALLEY, DEBRA SUE (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:SUE
Last Name:MALLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:88 LAKEVIEW DR S
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:GIBBSBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08026-1229
Mailing Address - Country:US
Mailing Address - Phone:856-309-0345
Mailing Address - Fax:856-309-1213
Practice Address - Street 1:88 LAKEVIEW DR S
Practice Address - Street 2:SUITE 2A
Practice Address - City:GIBBSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08026-1229
Practice Address - Country:US
Practice Address - Phone:856-309-0345
Practice Address - Fax:856-309-1213
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA63875207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ870898Medicare ID - Type Unspecified
NJG28015Medicare UPIN