Healthcare Provider Details

I. General information

NPI: 1265147086
Provider Name (Legal Business Name): MR. ANGEL RAUL DELCID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 01/16/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 MAIN ST
MATAWAN NJ
07747-3104
US

IV. Provider business mailing address

166 MAIN ST
MATAWAN NJ
07747-3104
US

V. Phone/Fax

Practice location:
  • Phone: 732-290-9040
  • Fax:
Mailing address:
  • Phone: 732-290-9040
  • Fax: 732-566-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: