Healthcare Provider Details

I. General information

NPI: 1508396276
Provider Name (Legal Business Name): DENNIS ANTHONY DEBERNARDIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JOURNAL SQUARE PLAZA 2ND FL
JERSEY CITY NJ
07306-4004
US

IV. Provider business mailing address

833 CHESTNUT ST STE 520
PHILADELPHIA PA
19107-4430
US

V. Phone/Fax

Practice location:
  • Phone: 888-636-7840
  • Fax: 267-479-1321
Mailing address:
  • Phone: 267-339-7843
  • Fax: 267-339-3761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number322575
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number322575
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number25MB12295500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: