Healthcare Provider Details

I. General information

NPI: 1932479706
Provider Name (Legal Business Name): DIANA FIBISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 LEXINGTON AVE
CLIFTON NJ
07011-1923
US

IV. Provider business mailing address

533 LEXINGTON AVE
CLIFTON NJ
07011-1923
US

V. Phone/Fax

Practice location:
  • Phone: 973-546-6844
  • Fax: 973-546-7707
Mailing address:
  • Phone: 973-546-6844
  • Fax: 973-546-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA09781800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: