Basic Information
| Provider Information | |||||||||
| NPI: | 1295120699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DISABATINO | ||||||||
| FirstName: | DANIEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 227 LAUREL RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | VOORHEES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080438303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566696050 | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 S ORANGE AVE STE 290 | ||||||||
| Address2: | |||||||||
| City: | LIVINGSTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9737401330 | ||||||||
| FaxNumber: | 9737408998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/02/2015 | ||||||||
| LastUpdateDate: | 08/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | 25MB10509100 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.