Debra Iwanow, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

001234 Issued in NY

Practice address

169 Riverside Dr
Binghamton, NY 13905-4246

Phone

(607) 592-1225

NPI assigned

Jun 18, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592438400000",
    "number": "1184240889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 DELVIEW TER",
            "city": "DELHI",
            "state": "NY",
            "postal_code": "137531056",
            "telephone_number": "607-592-1225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "169 RIVERSIDE DR",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139054246",
            "telephone_number": "607-592-1225"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "712 Farm To Market Rd",
            "address_purpose": "LOCATION",
            "city": "Endwell",
            "state": "NY",
            "postal_code": "137601128",
            "country_code": "US",
            "telephone_number": "607-592-1225",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "IWANOW",
        "first_name": "DEBRA",
        "credential": "ATC, CSCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-18",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL3019",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "001234",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE LICENSE",
            "identifier": "001234",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA STATE LICENSE",
            "identifier": "AL3019",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abraham Isaac
• Sophia Marie Isenburg, LMSW
• Kimona Issa, MD
• Mathew Rogin Itteera, MD
• Atiyana Ivy
• William A Jackson, RPA
• Joseph M Jaen, DMD
• Sabrina Jahan
• Kristin Lee Jamba
• Caylie Caroline James, M.S., CCC-SLP

• Athletic Trainer in Binghamton, NY
• Providers in Binghamton, NY by specialty
• Athletic Trainer in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.