Provider Demographics
NPI:1457423337
Name:DELIA, THOMAS GERARD (DC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:GERARD
Last Name:DELIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 UNION AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2127
Mailing Address - Country:US
Mailing Address - Phone:973-751-5592
Mailing Address - Fax:973-751-8849
Practice Address - Street 1:387 UNION AVENUE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2127
Practice Address - Country:US
Practice Address - Phone:973-751-5592
Practice Address - Fax:973-751-8849
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC01443111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1083805Medicaid
DE449948Medicare ID - Type Unspecified
NJ1083805Medicaid