Provider Demographics
NPI:1609804780
Name:DELARA, DANIEL ALEJANDRINO (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALEJANDRINO
Last Name:DELARA
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:HUNTERDON DEVELOPMENTAL CENTER
Mailing Address - Street 2:40 PITTSTOWN ROAD
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-4003
Mailing Address - Country:US
Mailing Address - Phone:908-735-4031
Mailing Address - Fax:908-730-1340
Practice Address - Street 1:HUNTERDON DEVELOPMENTAL CENTER
Practice Address - Street 2:40 PITTSTOWN ROAD
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-4003
Practice Address - Country:US
Practice Address - Phone:908-735-4031
Practice Address - Fax:908-730-1340
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05278900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089639B1LOtherMEDICARE BILLING NO.
NJF53632Medicare UPIN