Provider Demographics
NPI:1679505879
Name:CEFALU, DIMITRI (MD)
Entity Type:Individual
Prefix:
First Name:DIMITRI
Middle Name:
Last Name:CEFALU
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 1:1900 ROUTE 35
Mailing Address - Street 2:STE 300
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-2758
Mailing Address - Country:US
Mailing Address - Phone:732-531-5509
Mailing Address - Fax:732-531-5164
Practice Address - Street 1:3000 ESSEX RD
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07753-2631
Practice Address - Country:US
Practice Address - Phone:732-643-2070
Practice Address - Fax:732-643-2015
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA04689800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5221142040OtherBCBS OF NJ
04-09805OtherEVERCARE
NJ0021890Medicaid
NJ0021890Medicaid
533394MVKMedicare PIN
P00448422Medicare PIN
04-09805OtherEVERCARE
E73491Medicare UPIN