Provider Demographics
NPI:1548255102
Name:PINCUS, DEBRA (MD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:PINCUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 INDIAN HEAD RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-3705
Mailing Address - Country:US
Mailing Address - Phone:631-269-0180
Mailing Address - Fax:631-269-0178
Practice Address - Street 1:65 INDIAN HEAD RD
Practice Address - Street 2:SUITE 2
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754-3705
Practice Address - Country:US
Practice Address - Phone:631-269-0180
Practice Address - Fax:631-269-0178
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-13
Provider Licenses
StateLicense IDTaxonomies
NY183029207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01709571Medicaid
NY562081Medicare ID - Type Unspecified
NYF32031Medicare UPIN