Provider Demographics
NPI:1245457928
Name:DELORETO, PETER RICHARD (CRNA)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:RICHARD
Last Name:DELORETO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CORNFIELD LANE
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE STATION
Mailing Address - State:NJ
Mailing Address - Zip Code:08889-3356
Mailing Address - Country:US
Mailing Address - Phone:908-236-2304
Mailing Address - Fax:
Practice Address - Street 1:10 CORNFIELD LANE
Practice Address - Street 2:
Practice Address - City:WHITEHSE STATION
Practice Address - State:NJ
Practice Address - Zip Code:08889-3356
Practice Address - Country:US
Practice Address - Phone:908-236-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO07827300367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ035075Medicare ID - Type Unspecified