Healthcare Provider Details

I. General information

NPI: 1235440926
Provider Name (Legal Business Name): MATTHEW J. DELUCA, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 06/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BROAD ST
BLOOMFIELD NJ
07003-2764
US

IV. Provider business mailing address

265 BROAD ST
BLOOMFIELD NJ
07003-2764
US

V. Phone/Fax

Practice location:
  • Phone: 973-566-0300
  • Fax: 973-566-0303
Mailing address:
  • Phone: 973-566-0300
  • Fax: 973-566-0303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA0044133
License Number StateNJ

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MATTHEW J DELUCA
Title or Position: PRESIDENT
Credential: MD
Phone: 973-566-0300