Provider Demographics
NPI:1801835905
Name:DALY, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:DALY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-0065
Mailing Address - Country:US
Mailing Address - Phone:856-292-8216
Mailing Address - Fax:856-848-3011
Practice Address - Street 1:100 W RED BANK AVE
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3407
Practice Address - Country:US
Practice Address - Phone:856-292-8216
Practice Address - Fax:856-848-3011
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07143300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8421803Medicaid
NJH30733Medicare UPIN
NJ8421803Medicaid