Healthcare Provider Details

I. General information

NPI: 1104856434
Provider Name (Legal Business Name): EULALIA DIBATTISTE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 US HIGHWAY 9 STE 2
LANOKA HARBOR NJ
08734-2818
US

IV. Provider business mailing address

411 US HIGHWAY 9 STE 2
LANOKA HARBOR NJ
08734-2818
US

V. Phone/Fax

Practice location:
  • Phone: 609-693-0819
  • Fax: 609-971-0834
Mailing address:
  • Phone: 609-693-0819
  • Fax: 609-971-0834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA02980100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: