Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD045469L | PA |
NPI | 1114984085 |
---|---|
Provider Name | Joseph N Dibello JR. |
First Address | Huntingdon Valley, PA 19006-6128 |
Second Address | Huntingdon Valley, PA 19006-6128 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 17/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G49226 | (02) |