Provider Demographics
NPI:1962546028
Name:DELLACROCE LEE & HARDESTY
Entity type:Organization
Organization Name:DELLACROCE LEE & HARDESTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOESPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:DELLACROCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-392-2737
Mailing Address - Street 1:416 BELLEVUE AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08618-4513
Mailing Address - Country:US
Mailing Address - Phone:609-392-2737
Mailing Address - Fax:609-392-2191
Practice Address - Street 1:416 BELLEVUE AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-4513
Practice Address - Country:US
Practice Address - Phone:609-392-2737
Practice Address - Fax:609-392-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52630208600000X
NJMA688592086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2564807Medicaid
NJ2564807Medicaid
NJ148825Medicare ID - Type Unspecified