Healthcare Provider Details

I. General information

NPI: 1598889818
Provider Name (Legal Business Name): CHRISTINA MARIE DILIBERTO-BULS MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WOODLAND AVE
PLAINFIELD NJ
07060-3362
US

IV. Provider business mailing address

264 SHADY OAK CT
PISCATAWAY NJ
08854-3065
US

V. Phone/Fax

Practice location:
  • Phone: 908-753-1113
  • Fax: 908-753-9558
Mailing address:
  • Phone: 732-968-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00826700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: