Healthcare Provider Details

I. General information

NPI: 1720447709
Provider Name (Legal Business Name): DIFELICE ORTHOPAEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 E RIDGEWOOD AVE SUITE 175S
PARAMUS NJ
07652-3917
US

IV. Provider business mailing address

PO BOX 626
GREAT RIVER NY
11739-0626
US

V. Phone/Fax

Practice location:
  • Phone: 212-606-1844
  • Fax: 212-746-8744
Mailing address:
  • Phone: 212-606-1844
  • Fax: 212-746-8744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number25MA09393500
License Number StateNJ

VIII. Authorized Official

Name: DR. GREGORY S DIFELICE
Title or Position: OWNER
Credential: MD
Phone: 212-606-1844