Provider Demographics
NPI:1376045278
Name:DIBERNARD, KARALINE IRENE
Entity Type:Individual
Prefix:
First Name:KARALINE
Middle Name:IRENE
Last Name:DIBERNARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:BOONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07005-9629
Mailing Address - Country:US
Mailing Address - Phone:973-335-9877
Mailing Address - Fax:
Practice Address - Street 1:503 PINE BROOK RD
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1801
Practice Address - Country:US
Practice Address - Phone:973-769-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00803300225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist