Healthcare Provider Details

I. General information

NPI: 1629026919
Provider Name (Legal Business Name): JOSEPH JOHN DALLESSIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/24/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 2ND AVE FL 3
LONG BRANCH NJ
07740-6303
US

IV. Provider business mailing address

379 CAMPUS DR FL 4
SOMERSET NJ
08873-1161
US

V. Phone/Fax

Practice location:
  • Phone: 732-923-7250
  • Fax:
Mailing address:
  • Phone: 732-937-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number036112755
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25MA06236100
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME59520
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number25942
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number01061908A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD38247
License Number StateTN
# 7
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number10858
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: