Provider Demographics
NPI:1770588535
Name:GARIBALDI, ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:GARIBALDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 SHARON RD
Mailing Address - Street 2:STE 3
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-3147
Mailing Address - Country:US
Mailing Address - Phone:724-775-4099
Mailing Address - Fax:724-775-3510
Practice Address - Street 1:701 SHARON RD
Practice Address - Street 2:STE 3
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-3147
Practice Address - Country:US
Practice Address - Phone:724-775-4099
Practice Address - Fax:724-775-3510
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024943E207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5163200Medicaid
NJ050623CP0Medicare PIN
NJA12462Medicare UPIN