Healthcare Provider Details

I. General information

NPI: 1710980131
Provider Name (Legal Business Name): DENIS DILALLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 MAIN ST
PATERSON NJ
07503-2621
US

IV. Provider business mailing address

PO BOX 279
RUTHERFORD NJ
07070-0279
US

V. Phone/Fax

Practice location:
  • Phone: 973-754-2555
  • Fax: 973-754-2567
Mailing address:
  • Phone: 973-773-0100
  • Fax: 973-773-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMA51375
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: