Provider Demographics
NPI:1679647192
Name:FERNANDO DELASOTTA MD PA
Entity Type:Organization
Organization Name:FERNANDO DELASOTTA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BIRNBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-927-1000
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:598 NEW RD
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-0385
Mailing Address - Country:US
Mailing Address - Phone:609-927-1000
Mailing Address - Fax:609-653-6852
Practice Address - Street 1:598 NEW RD
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1241
Practice Address - Country:US
Practice Address - Phone:609-927-1000
Practice Address - Fax:609-653-6852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ520237Medicare ID - Type Unspecified