Healthcare Provider Details

I. General information

NPI: 1205579315
Provider Name (Legal Business Name): EDWARD MATTHEW DELESKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2022
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 WHITE HORSE PIKE
HADDON HEIGHTS NJ
08035-1709
US

IV. Provider business mailing address

1 FEDERAL ST STE 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-546-7990
  • Fax:
Mailing address:
  • Phone: 848-288-6935
  • Fax: 856-321-0090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA12662900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: