Provider Demographics
NPI:1407860406
Name:BISBERG, DOROTHY STEIN
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:STEIN
Last Name:BISBERG
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 1:271 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1630
Mailing Address - Country:US
Mailing Address - Phone:973-763-3456
Mailing Address - Fax:973-322-6999
Practice Address - Street 1:375 MOUNT PLEASANT AVE.
Practice Address - Street 2:SUITE 105
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-322-6900
Practice Address - Fax:973-322-6999
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA052289002080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2270803Medicaid
A61969Medicare UPIN
NJ2270803Medicaid