Provider Demographics
NPI:1629041231
Name:DALTON, JOHN B (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:DALTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:368 MEADOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2315
Mailing Address - Country:US
Mailing Address - Phone:732-542-4635
Mailing Address - Fax:
Practice Address - Street 1:552 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-5239
Practice Address - Country:US
Practice Address - Phone:732-222-7800
Practice Address - Fax:732-571-2075
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07358300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP3597459OtherOXFORD
NJ2K9152OtherHEALTHNET
NJ2K9152OtherHEALTHNET
NJP3597459OtherOXFORD