Provider Demographics
NPI:1992851984
Name:DELEONARDIS, JOHN A (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:DELEONARDIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8 HIGH ST
Mailing Address - Street 2:SUITE 1 B
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9540
Mailing Address - Country:US
Mailing Address - Phone:856-223-9355
Mailing Address - Fax:856-223-1693
Practice Address - Street 1:8B HIGH ST
Practice Address - Street 2:
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-9540
Practice Address - Country:US
Practice Address - Phone:856-223-9355
Practice Address - Fax:856-223-1693
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05586000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2060604Medicaid
NJ223536230OtherTIN
NJ223536230OtherTIN