MEDICARE: DR. EMIL I LABIB D.M.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
1	1223G0001X	General Practice Dentistry	22DI01959500	NJ
2	1223G0001X	General Practice Dentistry	22D01959503	NJ
3	1223G0001X	General Practice Dentistry	050504-1	NY

General Provider Information

NPI Number	:	1952501132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMIL I LABIB D.M.D.

Provider Business Mailing Address
First Line	:	1433 43RD ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-2764
Country	:	US
Telephone Number	:	973-858-0423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1433 43RD ST
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-2764
Country	:	US
Telephone Number	:	973-858-0423
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	08/12/2010

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