Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 6833 | MD |
N | 1223P0106X | Oral and Maxillofacial Pathology | DI02457900 | NJ |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS019214L | PA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 22D102457901 | NJ |
NPI | 1124076500 |
---|---|
Provider Name | Dr. Carl Angelo Bifano |
First Address | Camden, NJ 08103-1155 |
Second Address | Sewell, NJ 08080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 01/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1025303770001 | (05) | PA |
DI02457900 | STATE LICENSE (01) | NJ |
DS019214L | LICENSE (01) | PA |