Provider Demographics
NPI:1740284595
Name:DIPASQUALE, ALBERT MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:MARTIN
Last Name:DIPASQUALE
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 1:104 EASTON CT
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-4309
Mailing Address - Country:US
Mailing Address - Phone:609-670-0638
Mailing Address - Fax:
Practice Address - Street 1:813 EAST GATE DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054
Practice Address - Country:US
Practice Address - Phone:856-222-9119
Practice Address - Fax:856-222-9907
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04524300207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2329409Medicaid
NJ631928Medicare PIN
B36476Medicare UPIN