Provider Demographics
NPI:1225666787
Name:DELLAVECCHIA, NICHOLAS A
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:A
Last Name:DELLAVECCHIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 STRAWBRIDGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-4602
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:4000 CHURCH RD
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-1110
Practice Address - Country:US
Practice Address - Phone:856-281-7500
Practice Address - Fax:856-638-5003
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01919800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist