Provider Demographics
NPI:1588053979
Name:KRUBLIT, DEBRA (PT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:KRUBLIT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:FUGGINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:2 ELM DR
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1110
Mailing Address - Country:US
Mailing Address - Phone:516-694-7509
Mailing Address - Fax:516-694-7509
Practice Address - Street 1:2 ELM DR
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1110
Practice Address - Country:US
Practice Address - Phone:516-694-7509
Practice Address - Fax:516-694-7509
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0102892251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics