Healthcare Provider Details

I. General information

NPI: 1801898499
Provider Name (Legal Business Name): WILLIAM J DELIBERIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 E CHESTNUT AVE SUITE D 2
VINELAND NJ
08361-8400
US

IV. Provider business mailing address

2630 E CHESTNUT AVE SUITE D 2
VINELAND NJ
08361-8400
US

V. Phone/Fax

Practice location:
  • Phone: 856-696-4759
  • Fax: 856-696-4565
Mailing address:
  • Phone: 856-696-4759
  • Fax: 856-696-4565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number25MD00123900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: