Provider Demographics
NPI:1073001434
Name:DELIBERO, REGINE
Entity Type:Individual
Prefix:
First Name:REGINE
Middle Name:
Last Name:DELIBERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:REGINE
Other - Middle Name:
Other - Last Name:BAISAS-JANOLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:680 KINDERKAMACK RD
Mailing Address - Street 2:STE 300
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1600
Mailing Address - Country:US
Mailing Address - Phone:201-881-7869
Mailing Address - Fax:201-342-7171
Practice Address - Street 1:680 KINDERKAMACK RD STE 300
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1600
Practice Address - Country:US
Practice Address - Phone:201-342-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant