Provider Demographics
NPI:1194871459
Name:DITURO, JOSEPH WILLIAM (MD ND BCIM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:DITURO
Suffix:
Gender:M
Credentials:MD ND BCIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:EAST RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1792
Mailing Address - Country:US
Mailing Address - Phone:201-460-0302
Mailing Address - Fax:201-460-0348
Practice Address - Street 1:242 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:EAST RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1792
Practice Address - Country:US
Practice Address - Phone:201-460-0302
Practice Address - Fax:201-460-0348
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153651-1207R00000X
NM2002-0357207R00000X
NJ25MA04281900207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2008408Medicaid
NJD07113Medicare UPIN