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General NPI Number Information
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NPI Number | 1942553003
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Entity Type | Organization
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Legal Business Name | CHARLES G. GARBACCIO, MDPA
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 2 DEAN DR
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City | TENAFLY
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State | NJ
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Zip | 07670-2765
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Country | US
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Telephone | 201-567-1380
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Fax | 201-567-9106
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Provider Business Mailing Address
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Address Line | 2 DEAN DR
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City | TENAFLY
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State | NJ
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Zip | 07670-2765
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Country | US
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Telephone | 201-567-1380
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Fax | 201-567-9106
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES G GARBACCIO
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Credential | MD
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Telephone | 201-567-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 25MA03096600
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License Number State | NJ
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