Individual
DR. JOHN EDWARD DELORIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3835 204TH ST, BAYSIDE, NY 11361
(718) 974-1879
Mailing address
3835 204TH ST, BAYSIDE, NY 11361-1864
(718) 974-1879
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
135764-1
NY
Other
Enumeration date
11/15/2012
Last updated
11/08/2019
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