Provider Demographics
NPI:1528169786
Name:DIBARTOLO, LINDA MANDATA (DC)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MANDATA
Last Name:DIBARTOLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:ANN
Other - Last Name:MANDATA-DIBARTOLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:4036 OCEAN HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-7505
Mailing Address - Country:US
Mailing Address - Phone:609-926-1100
Mailing Address - Fax:609-926-0054
Practice Address - Street 1:4036 OCEAN HEIGHTS AVE
Practice Address - Street 2:
Practice Address - City:EGG HARBOR TWP
Practice Address - State:NJ
Practice Address - Zip Code:08234-7505
Practice Address - Country:US
Practice Address - Phone:609-926-1100
Practice Address - Fax:609-926-0054
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MCOO3552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010698719OtherGROUP EIN
NJ010698719OtherGROUP EIN
NJT45666Medicare UPIN