Provider Demographics
NPI:1972716769
Name:E.M. DELLAGATTA PT PA
Entity Type:Organization
Organization Name:E.M. DELLAGATTA PT PA
Other - Org Name:MAPLE LEAF PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DELLAGATTA
Authorized Official - Suffix:
Authorized Official - Credentials:MED, DPT
Authorized Official - Phone:609-561-1974
Mailing Address - Street 1:255 MESSINA AVE
Mailing Address - Street 2:PO BOX 663
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1327
Mailing Address - Country:US
Mailing Address - Phone:609-561-1974
Mailing Address - Fax:609-567-3148
Practice Address - Street 1:255 MESSINA AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1327
Practice Address - Country:US
Practice Address - Phone:609-561-1974
Practice Address - Fax:609-567-3148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00109200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP1709594OtherOXFORD
NJ67001OtherCIGNA
NJ3K4079OtherHEALTHNET
NJ055839OtherAETNA
NJ=========OtherAARP
NJP1709594OtherOXFORD
NJ055839OtherAETNA
NJ=========OtherGEHA
NJ417202Medicare UPIN