=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588740245
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCENT HEAD AND NECK GROUP, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2021 NEW RD SUITE 1
-----------------------------------------------------
City | LINWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08221-1045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-926-5556
-----------------------------------------------------
Fax | 609-926-5355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2021 NEW RD SUITE 1
-----------------------------------------------------
City | LINWOOD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08221-1045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-926-5556
-----------------------------------------------------
Fax | 609-926-5355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DELEGATED OFFICIAL
-----------------------------------------------------
Name | NICOLA DELORIO
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 609-926-5556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 25MB06497500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------