Individual
DR. JOHN P DETULLIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.C.C.P.
Contact information
Practice address
901 W MAIN ST, SUITE 160, CN 5050, FREEHOLD, NJ 07728-2537
(732) 577-0600
(732) 577-6332
Mailing address
901 W MAIN ST, SUITE 160, CN 5050, FREEHOLD, NJ 07728-2537
(732) 577-0600
(732) 577-6332
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
25MA04345700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03F88
EMPIRE BCBS
NY
01
—
110098315
MEDICARE RAILROAD
NJ
05
—
1431005
—
NJ
01
—
223019073
TAX IDENTIFICATION NUMBER
NJ
01
—
223019073-002
QUALCARE
NJ
01
—
4093697
AETNA
NJ
01
—
41014
AETNA
NJ
01
—
F00797
HEALTH NET OF NJ
NJ
01
—
MS044
OXFORD
NJ
Enumeration date
08/18/2006
Last updated
11/04/2008
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