Basic Information
Provider Information
NPI: 1356402705
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FOGLIA
FirstName: DEBORAH
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2094 ALBANY POST RD
Address2:  
City: MONTROSE
State: NY
PostalCode: 105481454
CountryCode: US
TelephoneNumber: 9147374400
FaxNumber: 9147884825
Practice Location
Address1: 2094 ALBANY POST RD
Address2:  
City: MONTROSE
State: NY
PostalCode: 105481454
CountryCode: US
TelephoneNumber: 9147374400
FaxNumber: 9147884825
Other Information
ProviderEnumerationDate: 12/12/2006
LastUpdateDate: 03/17/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X185867NYY193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
2084P0804X185867NYN Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry

No ID Information.


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