Provider Demographics
NPI:1851438675
Name:DELAVERDAC, CLAUDE L (DO, FACP)
Entity Type:Individual
Prefix:DR
First Name:CLAUDE
Middle Name:L
Last Name:DELAVERDAC
Suffix:
Gender:M
Credentials:DO, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 E SIMSBURY CT
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-3032
Mailing Address - Country:US
Mailing Address - Phone:609-652-9933
Mailing Address - Fax:609-652-9955
Practice Address - Street 1:310 CHRIS GAUPP DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4461
Practice Address - Country:US
Practice Address - Phone:609-652-9933
Practice Address - Fax:609-652-9955
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02500100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ195242Medicare ID - Type Unspecified
NJC54393Medicare UPIN