Provider Demographics
NPI:1194858654
Name:DELFINO, GREGORY (MACCC-A)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:DELFINO
Suffix:
Gender:M
Credentials:MACCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 PRINCETON DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9168
Mailing Address - Country:US
Mailing Address - Phone:610-694-0141
Mailing Address - Fax:610-317-8483
Practice Address - Street 1:1415 PRINCETON DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-9168
Practice Address - Country:US
Practice Address - Phone:610-694-0141
Practice Address - Fax:610-317-8483
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MG00057900231H00000X
PAAT000421L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7319052OtherAETNA
PA50005058OtherCAPITAL BLUE CROSS
PA054293-TF8Medicare UPIN