Provider Demographics
NPI:1326116708
Name:ACCHITELLI, DOMINIC ANTHONY (AT,C)
Entity Type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:ANTHONY
Last Name:ACCHITELLI
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1794 WITHERSPOON CT
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2216
Mailing Address - Country:US
Mailing Address - Phone:856-589-8477
Mailing Address - Fax:
Practice Address - Street 1:501 JARVIS RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-2169
Practice Address - Country:US
Practice Address - Phone:856-232-9703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT00059500390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program