Provider Demographics
NPI:1033255096
Name:JOHN M DALENA AND DARREN R BLUMBERG MD LLC
Entity Type:Organization
Organization Name:JOHN M DALENA AND DARREN R BLUMBERG MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-401-0500
Mailing Address - Street 1:65 RIDGEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-1313
Mailing Address - Country:US
Mailing Address - Phone:973-401-0500
Mailing Address - Fax:973-401-9306
Practice Address - Street 1:65 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1313
Practice Address - Country:US
Practice Address - Phone:973-401-0500
Practice Address - Fax:973-401-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ099533Medicare PIN
NJE28795Medicare UPIN
NJH92247Medicare UPIN
NJI53316Medicare UPIN