Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 25MA05499700 | NJ |
NPI | 1013000413 |
---|---|
Provider Name | Dr. Emanuel Corbo |
First Address | Leonia, NJ 07605-1421 |
Second Address | Roselle Park, NJ 07204-2428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4526007 | (05) | NJ |
F47323 | (02) | NJ |