Provider Demographics
NPI:1629005061
Name:EGITTO, DENNIS J (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:EGITTO
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 1:860 U.S. HWY #1,SUITE103
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3825
Mailing Address - Country:US
Mailing Address - Phone:561-622-4326
Mailing Address - Fax:561-626-2827
Practice Address - Street 1:860 US HIGHWAY 1
Practice Address - Street 2:SUITE 103
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3879
Practice Address - Country:US
Practice Address - Phone:561-622-4326
Practice Address - Fax:561-626-2827
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2019-10-07
Deactivation Date:2009-01-27
Deactivation Code:
Reactivation Date:2009-02-11
Provider Licenses
StateLicense IDTaxonomies
FLME37622207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL61169OtherBCBS PIN
FLD21819Medicare UPIN