Provider Demographics
NPI:1922008812
Name:DELORIO, NICOLA
Entity Type:Individual
Prefix:
First Name:NICOLA
Middle Name:
Last Name:DELORIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 STONE HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2170
Mailing Address - Country:US
Mailing Address - Phone:609-465-4667
Mailing Address - Fax:609-465-9387
Practice Address - Street 1:307 STONE HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2170
Practice Address - Country:US
Practice Address - Phone:609-465-4667
Practice Address - Fax:609-465-9387
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06497500174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2397345OtherAETNA HMO #
NJ7626509Medicaid
NJ0305190000OtherAMERIHEALTH #
NJP2117494OtherOXFORD #
NJ5566604OtherAETNA PPO #
NJ2K3254OtherHEALTHNET #
NJ2397345OtherAETNA HMO #
NJ0305190000OtherAMERIHEALTH #