Healthcare Provider Details

I. General information

NPI: 1215911987
Provider Name (Legal Business Name): DYANNE WESTERBERG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3156 RIVER RD
CAMDEN NJ
08105-4242
US

IV. Provider business mailing address

3 COOPER PLZ SUITE 502
CAMDEN NJ
08103-1438
US

V. Phone/Fax

Practice location:
  • Phone: 856-963-0126
  • Fax: 856-365-0279
Mailing address:
  • Phone: 856-342-2921
  • Fax: 856-968-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08313300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS005360L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: