Healthcare Provider Details

I. General information

NPI: 1134177710
Provider Name (Legal Business Name): RONALD PATRICK DELLANNO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 BROAD ST
BLOOMFIELD NJ
07003-2762
US

IV. Provider business mailing address

532 BROAD ST
BLOOMFIELD NJ
07003-2762
US

V. Phone/Fax

Practice location:
  • Phone: 973-429-9650
  • Fax: 973-743-9693
Mailing address:
  • Phone: 973-429-9650
  • Fax: 973-743-9693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00176300
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0053904
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerGHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: