Provider Demographics
NPI:1700069564
Name:DELLAGATTA, ENRICO MICHAEL (PT)
Entity type:Individual
Prefix:DR
First Name:ENRICO
Middle Name:MICHAEL
Last Name:DELLAGATTA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MESSINA AVE
Mailing Address - Street 2:PO BOX 663
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1327
Mailing Address - Country:US
Mailing Address - Phone:609-561-1974
Mailing Address - Fax:
Practice Address - Street 1:255 MESSINA AVE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1327
Practice Address - Country:US
Practice Address - Phone:609-561-1974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00109200225100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ417202Medicare UPIN