Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | MD002204 | NJ |
NPI | 1093898975 |
---|---|
Provider Name | Dr. Douglas N Delorenzo |
First Address | Kendall Park, NJ 08824 |
Second Address | Kendall Park, NJ 08824-1524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 30/07/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U49693 | (02) | NJ |