Basic Information
| Provider Information | |||||||||
| NPI: | 1558464073 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOSEFSON | ||||||||
| FirstName: | DEBORAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 DIAMOND HILL RD | ||||||||
| Address2: | |||||||||
| City: | BERKELEY HEIGHTS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079222104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082734300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1515 BROAD ST STE B120 | ||||||||
| Address2: | |||||||||
| City: | BLOOMFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070033059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9738737000 | ||||||||
| FaxNumber: | 9737438943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A064708 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 22038 | NE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101235369 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 33902 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 199813 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 200501268 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207ZP0101X | 199813 | NY | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 0101235369 | VA | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 33902 | AZ | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | ME93911 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 200501268 | NC | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 22038 | NE | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 36112999 | IL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology | 207ZP0101X | 25MA08683400 | NJ | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
ID Information
| ID | Type | State | Issuer | Description | 5098922 | 01 | NY | GHI | OTHER |