# E.M. DELLAGATTA PT PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Maple Leaf Physical Therapy
- **Organization subpart:** No

## Provider details

- **NPI number:** 1972716769
- **Authorized official:** DR. ENRICO MICHAEL DELLAGATTA M.ED, DPT (CEO)
- **Authorized official phone:** (609) 561-1974

## Contact information

- **Practice address:** 255 MESSINA AVE, HAMMONTON, NJ 08037-1327
- **Practice address phone:** (609) 561-1974
- **Practice address fax:** (609) 567-3148
- **Mailing address:** 255 MESSINA AVE, PO BOX 663, HAMMONTON, NJ 08037-1327
- **Mailing address phone:** (609) 561-1974
- **Mailing address fax:** (609) 567-3148

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 40QA00109200 | NJ | Yes |

## Other

- **Enumeration date:** 05/08/2007
- **Last updated:** 04/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 055839 | AETNA | NJ |
| 01 | — | 3K4079 | HEALTHNET | NJ |
| 01 | — | 67001 | CIGNA | NJ |
| 01 | — | P1709594 | OXFORD | NJ |