Provider Demographics
NPI:1699045187
Name:MARIA B. DEL VECCHIO, MD, LLC
Entity Type:Organization
Organization Name:MARIA B. DEL VECCHIO, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEL VECCHIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-509-2000
Mailing Address - Street 1:40 MACLEOD LN
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4306
Mailing Address - Country:US
Mailing Address - Phone:973-509-2000
Mailing Address - Fax:973-655-1228
Practice Address - Street 1:29 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3407
Practice Address - Country:US
Practice Address - Phone:973-509-2000
Practice Address - Fax:973-655-1228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04111600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty