Provider Demographics
NPI:1417001199
Name:DELUCA, ANTHONY JOHN (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:DELUCA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 687
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-0687
Mailing Address - Country:US
Mailing Address - Phone:732-679-2414
Mailing Address - Fax:732-679-1151
Practice Address - Street 1:2309 HIGHWAY 516
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-1865
Practice Address - Country:US
Practice Address - Phone:732-679-2414
Practice Address - Fax:732-679-1151
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ3441111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU43656Medicare UPIN
NJDE 447161Medicare PIN