Healthcare Provider Details

I. General information

NPI: 1972591147
Provider Name (Legal Business Name): ROBERT VINCENT DESILVERIO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 08/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 NEW RD
LINWOOD NJ
08221
US

IV. Provider business mailing address

1409 STOCTON ROAD
MEADOWBROOK PA
19046
US

V. Phone/Fax

Practice location:
  • Phone: 609-927-5885
  • Fax: 609-927-5565
Mailing address:
  • Phone: 215-688-1223
  • Fax: 866-865-1697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD419144
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberC1-0008078
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number25MA07850300
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD419144
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: