Provider Demographics
NPI:1710051305
Name:DELASOTTA, FERNANDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:J
Last Name:DELASOTTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 NEW RD
Mailing Address - Street 2:P. O. BOX 385
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1241
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA40035NJ207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery