Healthcare Provider Details

I. General information

NPI: 1396824256
Provider Name (Legal Business Name): JOSEPH P DILISI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 03/12/2012
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 Number25MB03492200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: