Basic Information
| Provider Information | |||||||||
| NPI: | 1013912302 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELUCCIO | ||||||||
| FirstName: | JUSTINE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | MSPT, OCS, FAAOMPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 MADISON AVE | ||||||||
| Address2: | STE 205 | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079607305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732921101 | ||||||||
| FaxNumber: | 9732924149 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 MADISON AVE | ||||||||
| Address2: | STE 205 | ||||||||
| City: | MORRISTOWN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 079607305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9732921101 | ||||||||
| FaxNumber: | 9732924149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA00601200 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.