Provider Demographics
NPI:1669539169
Name:PAUL DELL'AQUILA, M.D., P.C.
Entity type:Organization
Organization Name:PAUL DELL'AQUILA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:DELL'AQUILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-542-2880
Mailing Address - Street 1:339 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2738
Mailing Address - Country:US
Mailing Address - Phone:973-542-2880
Mailing Address - Fax:973-542-2881
Practice Address - Street 1:339 PASSAIC AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2738
Practice Address - Country:US
Practice Address - Phone:973-542-2880
Practice Address - Fax:973-542-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA00551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4583302Medicaid
NJ4583302Medicaid
NJE54378Medicare UPIN