Provider Demographics
NPI:1598056475
Name:MARIE BIBLONDE JOSEPH DPM PA
Entity Type:Organization
Organization Name:MARIE BIBLONDE JOSEPH DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:BIBLONDE
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:561-290-2610
Mailing Address - Street 1:4849 LAKE WORTH RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3455
Mailing Address - Country:US
Mailing Address - Phone:561-290-2610
Mailing Address - Fax:
Practice Address - Street 1:4849 LAKE WORTH RD
Practice Address - Street 2:SUITE101
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3455
Practice Address - Country:US
Practice Address - Phone:561-290-2610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-26
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFB952AMedicare PIN