Provider Demographics
NPI:1043471402
Name:PARK PEDIATRICS, PA
Entity Type:Organization
Organization Name:PARK PEDIATRICS, PA
Other - Org Name:EMANUEL CORBO, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-245-2442
Mailing Address - Street 1:443 E WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-2428
Mailing Address - Country:US
Mailing Address - Phone:908-245-2442
Mailing Address - Fax:908-245-6258
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:908-245-6258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05499700208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty