Provider Demographics
NPI:1205916509
Name:DELUCA, JOSEPH ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:DELUCA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PARK AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-1012
Mailing Address - Country:US
Mailing Address - Phone:201-896-0096
Mailing Address - Fax:201-896-0062
Practice Address - Street 1:20 PARK AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-1012
Practice Address - Country:US
Practice Address - Phone:201-896-0096
Practice Address - Fax:201-896-0062
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48353174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0840301Medicaid
NJ0840301Medicaid
NJE53719Medicare UPIN