Provider Demographics
NPI:1710038518
Name:DELAWARE VALLEY PEDORTHIC SERVICES, LLC
Entity Type:Organization
Organization Name:DELAWARE VALLEY PEDORTHIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:DI GIULIO
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:856-577-1984
Mailing Address - Street 1:137 COLWICK RD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1212
Mailing Address - Country:US
Mailing Address - Phone:856-577-1984
Mailing Address - Fax:
Practice Address - Street 1:295 ROUTE 70 W
Practice Address - Street 2:SUITE 101
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3096
Practice Address - Country:US
Practice Address - Phone:856-577-1984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ332B00000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5163920001Medicare NSC