Provider Demographics
NPI:1053561738
Name:DEBROSSE, ALENA (NPP)
Entity type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:DEBROSSE
Suffix:
Gender:F
Credentials:NPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801A POMPTON RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-7261
Mailing Address - Country:US
Mailing Address - Phone:516-312-9486
Mailing Address - Fax:
Practice Address - Street 1:16 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3005
Practice Address - Country:US
Practice Address - Phone:516-312-9486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF400569363LP0808X
NJ26NJ01046000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF400569-1OtherLICENSE