Provider Demographics
NPI:1336117332
Name:DIBIASE, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:DIBIASE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1225 WHITEHORSE MERCERVILLE RD
Mailing Address - Street 2:BLDG. D, SUITE 220
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3882
Mailing Address - Country:US
Mailing Address - Phone:609-581-2200
Mailing Address - Fax:609-581-1212
Practice Address - Street 1:1225 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:BLDG. D, SUITE 220
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-3882
Practice Address - Country:US
Practice Address - Phone:609-581-2200
Practice Address - Fax:609-581-1212
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-05-06
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA43822207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ722901Medicaid
NJ593231AMBMedicare PIN
NJ722901Medicaid