Provider Demographics
NPI:1013000413
Name:CORBO, EMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:
Last Name:CORBO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 PINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1421
Mailing Address - Country:US
Mailing Address - Phone:201-363-1256
Mailing Address - Fax:
Practice Address - Street 1:443 E WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-2428
Practice Address - Country:US
Practice Address - Phone:908-245-2442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05499700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4526007Medicaid
457310Medicare ID - Type Unspecified
NJF47323Medicare UPIN