Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 22D102406500 | NJ |
N | 213EG0000X | General Practice | 22D102406500 | NJ |
N | 1223G0001X | General Practice | P64200 | NY |
N | 213EG0000X | General Practice | P64200 | NY |
Y | 1223P0700X | Prosthodontist | 22DI02406500 | NJ |
NPI | 1225291552 |
---|---|
Provider Name | Dr. Erica C. Defabio |
First Address | Bedminster, NJ 07921-1643 |
Second Address | Colts Neck, NJ 07722-2513 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2008 |
Last Update Date | 18/07/2012 |