Provider Demographics
NPI:1154427912
Name:DE BELLIS, JEFFREY THOMAS (PT, MS, OCS)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:DE BELLIS
Suffix:
Gender:M
Credentials:PT, MS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-0264
Mailing Address - Country:US
Mailing Address - Phone:973-305-0064
Mailing Address - Fax:973-305-0074
Practice Address - Street 1:1055 HAMBURG TPKE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3235
Practice Address - Country:US
Practice Address - Phone:973-305-0064
Practice Address - Fax:973-305-0074
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01023300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01023300OtherSTATE LICENSE
223803579OtherTAXID
NJ066529Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID