Healthcare Provider Details

I. General information

NPI: 1346307451
Provider Name (Legal Business Name): DILISI FAMILY MEDICINE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N WOODBURY RD
PITMAN NJ
08071-1261
US

IV. Provider business mailing address

110 N WOODBURY RD
PITMAN NJ
08071-1261
US

V. Phone/Fax

Practice location:
  • Phone: 856-589-1212
  • Fax: 856-589-6635
Mailing address:
  • Phone: 856-589-1212
  • Fax: 856-589-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB34922
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSEPH P DILISI
Title or Position: PRINCIPAL
Credential: D.O.
Phone: 856-589-1212