Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 25MA05590900 | NJ |
NPI | 1164599262 |
---|---|
Provider Name | Dr. Barry E Dibernardo |
First Address | Montclair, NJ 07042-3407 |
Second Address | Montclair, NJ 07042-3407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 09/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E97435 | (02) | NJ |