Provider Demographics
NPI:1104159292
Name:DEROBERTIS, DINO CORRADO (DC)
Entity type:Individual
Prefix:DR
First Name:DINO
Middle Name:CORRADO
Last Name:DEROBERTIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 STONY RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-3722
Mailing Address - Country:US
Mailing Address - Phone:732-447-7990
Mailing Address - Fax:
Practice Address - Street 1:72 STONY RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-3722
Practice Address - Country:US
Practice Address - Phone:732-447-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00671800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor