Healthcare Provider Details

I. General information

NPI: 1104510890
Provider Name (Legal Business Name): DILLON FERRARI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FRONT ST STE 280
CONSHOHOCKEN PA
19428-2891
US

IV. Provider business mailing address

17 HERON CT
MEDFORD NJ
08055-8822
US

V. Phone/Fax

Practice location:
  • Phone: 484-351-8417
  • Fax:
Mailing address:
  • Phone: 856-905-0753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: