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General NPI Number Information
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NPI Number | 1760415384
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Entity Type | Individual
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Provider Name | DIMITRI LADDIS MD
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Gender | Male
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 06/18/2023
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Provider Practice Location Address
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Address Line | 481 S WASHINGTON AVE
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City | BERGENFIELD
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State | NJ
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Zip | 07621-4313
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Country | US
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Telephone | 201-875-2454
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Fax | 732-707-5001
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Provider Business Mailing Address
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Address Line | 31 LIBERTY ST
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City | PIERMONT
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State | NY
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Zip | 10968-1207
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Country | US
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Telephone | 917-974-7279
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 2288751
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 228875
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2080P0204X
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Taxonomy Name | Pediatric Emergency Medicine (Pediatrics) Physician
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License Number | 25MA10557500
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License Number State | NJ
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