Provider Demographics
NPI:1508455643
Name:DALBERIS, ROODY (DNP)
Entity Type:Individual
Prefix:
First Name:ROODY
Middle Name:
Last Name:DALBERIS
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MARSHALL ST APT 2P
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3652
Mailing Address - Country:US
Mailing Address - Phone:862-888-1530
Mailing Address - Fax:
Practice Address - Street 1:18 MARSHALL ST APT 2P
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3652
Practice Address - Country:US
Practice Address - Phone:862-888-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01053500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily