Provider Demographics
NPI:1013952332
Name:DELLORSO, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:DELLORSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:NEWARK AIRPORT MEDICAL OFFICES
Mailing Address - Street 2:NEWARK LIBERTY INT'L. AIRPORT, BUILDING #339
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07114-3710
Mailing Address - Country:US
Mailing Address - Phone:973-643-8383
Mailing Address - Fax:973-643-4744
Practice Address - Street 1:NEWARK AIRPORT MEDICAL OFFICES
Practice Address - Street 2:BREWSTER ROAD, BUILDING #339
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07114-3710
Practice Address - Country:US
Practice Address - Phone:973-643-8383
Practice Address - Fax:973-643-4744
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA68184207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine