Provider Demographics
NPI:1093898975
Name:DELORENZO, DOUGLAS N (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:N
Last Name:DELORENZO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 RT. 27
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824
Mailing Address - Country:US
Mailing Address - Phone:732-297-3002
Mailing Address - Fax:732-297-3004
Practice Address - Street 1:3228 STATE ROUTE 27
Practice Address - Street 2:SUITE 1B
Practice Address - City:KENDALL PARK
Practice Address - State:NJ
Practice Address - Zip Code:08824-1524
Practice Address - Country:US
Practice Address - Phone:732-297-3002
Practice Address - Fax:732-297-3004
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002204213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU49693Medicare UPIN
NJ331879Medicare PIN