Provider Demographics
NPI:1235329103
Name:DELLABELLA, PETER (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:DELLABELLA
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 1:62 BEVERLEY RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2403
Mailing Address - Country:US
Mailing Address - Phone:917-514-7979
Mailing Address - Fax:
Practice Address - Street 1:210 BELLEVUE AVE FL 2
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1821
Practice Address - Country:US
Practice Address - Phone:917-514-7979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD201132084P0804X, 2084P0800X, 2084P0005X
NJ25MA084803002084P0804X, 2084P0800X, 2084P0005X
NY1801052084P0804X, 2084P0005X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0005XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY180105OtherLICENSE NUMBER
NJ25MA08480300OtherNEW JERSEY MEDICAL LICENSE
MEMD20113OtherMAINE MEDICAL LICENSE