Provider Demographics
NPI:1649459066
Name:JOHN P. NEIBERT M.D.,P.C.
Entity type:Organization
Organization Name:JOHN P. NEIBERT M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-798-6200
Mailing Address - Street 1:10 HURON AVE
Mailing Address - Street 2:SUITE 1-L
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3641
Mailing Address - Country:US
Mailing Address - Phone:201-798-6200
Mailing Address - Fax:201-798-6207
Practice Address - Street 1:10 HURON AVE
Practice Address - Street 2:SUITE 1-L
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3641
Practice Address - Country:US
Practice Address - Phone:201-798-6200
Practice Address - Fax:201-798-6207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066666207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081453Medicare PIN