Provider Demographics
NPI:1609064583
Name:DELA BARERRA, JIM
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:DELA BARERRA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1083 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-2918
Mailing Address - Country:US
Mailing Address - Phone:973-338-1717
Mailing Address - Fax:973-338-1717
Practice Address - Street 1:1083 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-2918
Practice Address - Country:US
Practice Address - Phone:973-338-1717
Practice Address - Fax:973-338-1717
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD3037156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician