Basic Information
| Provider Information | |||||||||
| NPI: | 1992788756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DRIBBON | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.P.M. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 503 RARITAN AVE | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089042901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325720020 | ||||||||
| FaxNumber: | 7325720688 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 WESCOTT DR STE 303 | ||||||||
| Address2: | |||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088224600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087886449 | ||||||||
| FaxNumber: | 9087886668 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/25/2005 | ||||||||
| LastUpdateDate: | 01/07/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | 25MD00122000 | NJ | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3138801 | 05 | NJ | MEDICAID |