Provider Demographics
NPI:1235440926
Name:MATTHEW J. DELUCA, M.D., P.A.
Entity Type:Organization
Organization Name:MATTHEW J. DELUCA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:DELUCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-566-0300
Mailing Address - Street 1:265 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2764
Mailing Address - Country:US
Mailing Address - Phone:973-566-0300
Mailing Address - Fax:973-566-0303
Practice Address - Street 1:265 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2764
Practice Address - Country:US
Practice Address - Phone:973-566-0300
Practice Address - Fax:973-566-0303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA00441332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE13164Medicare UPIN