Provider Demographics
NPI:1942553003
Name:CHARLES G. GARBACCIO, MDPA
Entity Type:Organization
Organization Name:CHARLES G. GARBACCIO, MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:GARBACCIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-567-1380
Mailing Address - Street 1:2 DEAN DR
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2765
Mailing Address - Country:US
Mailing Address - Phone:201-567-1380
Mailing Address - Fax:201-567-9106
Practice Address - Street 1:2 DEAN DR
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2765
Practice Address - Country:US
Practice Address - Phone:201-567-1380
Practice Address - Fax:201-567-9106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03096600208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJGA452290Medicare PIN
NJC55307Medicare UPIN