Provider Demographics
NPI:1700834744
Name:DELVECCHIO, MARIA B (MDQ)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:B
Last Name:DELVECCHIO
Suffix:
Gender:F
Credentials:MDQ
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:BISIGNANO-DEL VECCHIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
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:973-985-3873
Mailing Address - Fax:973-256-3984
Practice Address - Street 1:181 FRANKLIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3820
Practice Address - Country:US
Practice Address - Phone:973-667-8117
Practice Address - Fax:973-667-6642
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04111600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE32872Medicare UPIN
NJ581582Medicare ID - Type Unspecified