Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 35SI00318900 | NJ |
Y | 103TC0700X | Clinical Psychologist | 35SI00318900 | NJ |
NPI | 1003922337 |
---|---|
Provider Name | Michael Dribbon |
First Address | Mountainside, NJ 07092-2590 |
Second Address | Mountainside, NJ 07092-2590 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |