Provider Demographics
NPI:1720447709
Name:DIFELICE ORTHOPAEDICS PC
Entity Type:Organization
Organization Name:DIFELICE ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIFELICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-746-4993
Mailing Address - Street 1:954 LEXINGTON AVE
Mailing Address - Street 2:BOX 700
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-5055
Mailing Address - Country:US
Mailing Address - Phone:212-746-4993
Mailing Address - Fax:
Practice Address - Street 1:140 E RIDGEWOOD AVE
Practice Address - Street 2:SUITE 175S
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3917
Practice Address - Country:US
Practice Address - Phone:212-746-4993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09393500207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty