Healthcare Provider Details

I. General information

NPI: 1346779535
Provider Name (Legal Business Name): DEIRDRE ANN DULAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BOWMAN DR STE E366
VOORHEES NJ
08043-9639
US

IV. Provider business mailing address

200 BOWMAN DR STE E366
VOORHEES NJ
08043-9639
US

V. Phone/Fax

Practice location:
  • Phone: 856-247-7295
  • Fax: 856-247-7118
Mailing address:
  • Phone: 856-247-7295
  • Fax: 856-247-7118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number25MA11941000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: