Provider Demographics
NPI:1669480489
Name:DELUCA, RUDOLPH JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:JOHN
Last Name:DELUCA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 MARLTON PIKE W
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3525
Mailing Address - Country:US
Mailing Address - Phone:856-428-3739
Mailing Address - Fax:
Practice Address - Street 1:501 MARLTON PIKE W
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3525
Practice Address - Country:US
Practice Address - Phone:856-428-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00165600213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2120402Medicaid
NJDE555556Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NJT44775Medicare UPIN