Provider Demographics
NPI:1033414487
Name:DEALWIS, DELAN TREVOR (MD)
Entity Type:Individual
Prefix:DR
First Name:DELAN
Middle Name:TREVOR
Last Name:DEALWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7601 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3207
Practice Address - Country:US
Practice Address - Phone:718-238-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2597122085R0202X
NJ25MA091210002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP01080395OtherRR MEDICARE
NJ0302040Medicaid
NJP01080386OtherRR MEDICARE
NJP01080379OtherRR MEDICARE
NJP01080386OtherRR MEDICARE
NJP01080379OtherRR MEDICARE
NJ243669ZEKDMedicare PIN