1205828787 NPI number — MR. JOHN M. DEPALMA D.P.M.

Table of content: MR. JOHN M. DEPALMA D.P.M. (NPI 1205828787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205828787 NPI number — MR. JOHN M. DEPALMA D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEPALMA
Provider First Name:
JOHN
Provider Middle Name:
M.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1205828787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 STOKES ROAD
Provider Second Line Business Mailing Address:
SUITE C-5
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-714-0052
Provider Business Mailing Address Fax Number:
609-714-3087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 STOKES ROAD
Provider Second Line Business Practice Location Address:
SUITE C-5
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-714-0052
Provider Business Practice Location Address Fax Number:
609-714-3087
Provider Enumeration Date:
08/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  MD002233 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 25MD00223300 , 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: 220463 . This is a "VSFHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0763611000 . This is a "AMERIHEALTH HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223434672 . This is a "AMER. PREFERRED PROVIDER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 223434672 . This is a "DIRECT CARE AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00000089143 . This is a "BETTER HEALTH ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 480034600 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 317027 . This is a "DIVON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000616345 . This is a "BC/BS PERSONAL CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0762611000 . This is a "KEYSTONE - EAST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0763611000 . This is a "AMERIHEALTH POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0763611000 . This is a "AMERIHEALTH PERSONAL CH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0763611000 . This is a "AMERIHEALTH PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: F17329 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000616345 . This is a "AMERIHEALTH ADMINISTRATOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4623650001 . This is a "HEALTH NOW" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8982930 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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