Healthcare Provider Details

I. General information

NPI: 1407860406
Provider Name (Legal Business Name): DR. DOROTHY STEIN BISBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 MOUNT PLEASANT AVE. SUITE 105
WEST ORANGE NJ
07052
US

IV. Provider business mailing address

271 FOREST RD
SOUTH ORANGE NJ
07079-1630
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-6900
  • Fax: 973-322-6999
Mailing address:
  • Phone: 973-763-3456
  • Fax: 973-322-6999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number25MA05228900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: