Provider Demographics
NPI:1689667297
Name:DELLOLIO, JOSEPH ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:DELLOLIO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4362 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1413
Mailing Address - Country:US
Mailing Address - Phone:718-994-7054
Mailing Address - Fax:718-325-0798
Practice Address - Street 1:4362 WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1413
Practice Address - Country:US
Practice Address - Phone:718-994-7054
Practice Address - Fax:718-325-0798
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-30
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0042221213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P44921Medicare ID - Type Unspecified
T51419Medicare UPIN