1972716769 NPI number — E.M. DELLAGATTA PT PA

Table of content: (NPI 1972716769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972716769 NPI number — E.M. DELLAGATTA PT PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
E.M. DELLAGATTA PT PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MAPLE LEAF PHYSICAL THERAPY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972716769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 MESSINA AVE
Provider Second Line Business Mailing Address:
PO BOX 663
Provider Business Mailing Address City Name:
HAMMONTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08037-1327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-561-1974
Provider Business Mailing Address Fax Number:
609-567-3148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 MESSINA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMMONTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08037-1327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-561-1974
Provider Business Practice Location Address Fax Number:
609-567-3148
Provider Enumeration Date:
05/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DELLAGATTA
Authorized Official First Name:
ENRICO
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
609-561-1974

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA00109200 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P1709594 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 67001 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 3K4079 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 055839 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com