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General NPI Number Information
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NPI Number | 1073618443
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Entity Type | Individual
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Provider Name | PABLO R IBARROLA M. D
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Gender | Male
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Dates
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Enumeration Date | 09/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 211 PENNINGTON AVE
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City | PASSAIC
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State | NJ
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Zip | 07055-4617
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Country | US
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Telephone | 973-470-3077
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Fax |
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Provider Business Mailing Address
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Address Line | 55 EUGENE CT
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City | TOWNSHIP OF WASHINGTON
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State | NJ
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Zip | 07676-4512
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Country | US
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Telephone | 201-523-0879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 25MA02953300
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License Number State | NJ
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