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NPI Code Detail

MEDICARE: DR. JOHN ROBERT CORBISIERO PH.D.

MEDICARE: DR. JOHN ROBERT CORBISIERO PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist2586NJ

General Provider Information

NPI Number : 1275576308
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN ROBERT CORBISIERO PH.D.
Provider Business Mailing Address
First Line : 179 S MAPLE AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-4541
Country : US
Telephone Number : 201-445-0662
Fax Number : 201-445-9073
Provider Business Practice Location Address
First Line : 179 S MAPLE AVE
Second Line :
City : RIDGEWOOD
State : NJ
Zip : 07450-4541
Country : US
Telephone Number : 201-445-0662
Fax Number : 201-445-9073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2006
Last Update Date : 04/15/2014

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