Provider Demographics
NPI:1942299920
Name:DELLOSSO, JOHN VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:VINCENT
Last Name:DELLOSSO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:314 W 14TH ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-5002
Mailing Address - Country:US
Mailing Address - Phone:646-638-4000
Mailing Address - Fax:646-638-1842
Practice Address - Street 1:314 W 14TH ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-5002
Practice Address - Country:US
Practice Address - Phone:646-638-4000
Practice Address - Fax:646-638-1842
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2014-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY197294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5876007OtherAETNA
NY15J051OtherBLUE CROSS
NYNP1376OtherOXFORD
NY01842231Medicaid
NY1942692OtherUNITED
NY914576/2C6576OtherHEALTH NET
NY435009N/4984895002OtherCIGNA
NY914576/2C6576OtherHEALTH NET
NYNP1376OtherOXFORD