Provider Demographics
NPI:1619958659
Name:DITILLO, BETTY A (APN)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:A
Last Name:DITILLO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 JACK MARTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-7732
Mailing Address - Country:US
Mailing Address - Phone:732-206-0800
Mailing Address - Fax:
Practice Address - Street 1:349 E NORTHFIELD RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-4806
Practice Address - Country:US
Practice Address - Phone:973-597-0900
Practice Address - Fax:973-597-0910
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07618800363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health