Provider Demographics
NPI:1275594707
Name:DELL'AQUILA, PAUL VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:VINCENT
Last Name:DELL'AQUILA
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 1:339 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2738
Mailing Address - Country:US
Mailing Address - Phone:973-542-2880
Mailing Address - Fax:973-542-2881
Practice Address - Street 1:339 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2738
Practice Address - Country:US
Practice Address - Phone:973-542-2880
Practice Address - Fax:973-542-2881
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55001207R00000X
NJ25MA05500100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4583302Medicaid
NJ4583302Medicaid
NJ108523Medicare PIN