MEDICARE: DR. JOHN VINCENT DELLOSSO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	197294	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5876007	OTHER	NY	AETNA
2	15J051	OTHER	NY	BLUE CROSS
3	NP1376	OTHER	NY	OXFORD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1942692	OTHER	NY	UNITED
6	914576/2C6576	OTHER	NY	HEALTH NET
7	435009N/4984895002	OTHER	NY	CIGNA

General Provider Information

NPI Number	:	1942299920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN VINCENT DELLOSSO MD

Provider Business Mailing Address
First Line	:	314 W 14TH ST
Second Line	:	1ST FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10014-5002
Country	:	US
Telephone Number	:	646-638-4000
Fax Number	:	646-638-1842

Provider Business Practice Location Address
First Line	:	314 W 14TH ST
Second Line	:	1ST FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10014-5002
Country	:	US
Telephone Number	:	646-638-4000
Fax Number	:	646-638-1842

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	02/04/2014

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