Provider Demographics
NPI:1215275573
Name:JOSEPH WILLIAM DITURO, P.C
Entity type:Organization
Organization Name:JOSEPH WILLIAM DITURO, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DITURO
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:201-460-0302
Mailing Address - Street 1:242 PATERSON AVE
Mailing Address - Street 2:
Mailing Address - City:E RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07073-1792
Mailing Address - Country:US
Mailing Address - Phone:201-460-0302
Mailing Address - Fax:
Practice Address - Street 1:242 PATERSON AVE
Practice Address - Street 2:
Practice Address - City:E RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07073-1792
Practice Address - Country:US
Practice Address - Phone:201-460-0302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04281900302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2008408Medicaid
NJ2008408Medicaid