Provider Demographics
NPI:1164492971
Name:DIMACULANGAN, NELO (MD)
Entity Type:Individual
Prefix:DR
First Name:NELO
Middle Name:
Last Name:DIMACULANGAN
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 1:4 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4510
Mailing Address - Country:US
Mailing Address - Phone:201-434-3997
Mailing Address - Fax:201-434-3304
Practice Address - Street 1:4 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4510
Practice Address - Country:US
Practice Address - Phone:201-434-3997
Practice Address - Fax:201-434-3304
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA069509208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA069509OtherMEDICAL LICENSE
NJMA069509OtherMEDICAL LICENSE