Provider Demographics
NPI:1598923468
Name:DIBELLO PLASTIC SURGERY
Entity Type:Organization
Organization Name:DIBELLO PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:DIBELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-947-4990
Mailing Address - Street 1:2361 HUNTINGDON PIKE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19006-6128
Mailing Address - Country:US
Mailing Address - Phone:215-947-4990
Mailing Address - Fax:215-947-7660
Practice Address - Street 1:2361 HUNTINGDON PIKE
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6128
Practice Address - Country:US
Practice Address - Phone:215-947-4990
Practice Address - Fax:215-947-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG49226Medicare UPIN