Provider Demographics
NPI:1639298581
Name:DEJESUS, DINO NICOL E (DO)
Entity Type:Individual
Prefix:
First Name:DINO NICOL
Middle Name:E
Last Name:DEJESUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:108 BILBY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-4174
Mailing Address - Country:US
Mailing Address - Phone:908-684-3005
Mailing Address - Fax:908-684-3301
Practice Address - Street 1:108 BILBY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-4174
Practice Address - Country:US
Practice Address - Phone:908-684-3005
Practice Address - Fax:908-684-3301
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB07828100207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8107063OtherCIGNA
NJ010046637OtherAMERICHOICE
NJ46931OtherUNIVERSITY HEALTH PLAN
NJP3947633OtherOXFORD
NJ0172014Medicaid
FL27845300-0Medicaid
NJ3551981000OtherAMERIHEALTH
NJ1899455/9558120OtherAETNA
NJ60042586OtherHORIZON NJ HEALTH
FL96156OtherBLUE CROSS/BLUE SHIELD
FL310401OtherAVMED
FL8107063OtherCIGNA
NJ3K8753OtherHEALTHNET
FLP00459920OtherRAILROAD MEDICARE
FL8107063OtherCIGNA
NJ3551981000OtherAMERIHEALTH