Provider Demographics
NPI:1902910805
Name:DELASOBERA, OCTAVIO FEDERICO (MD)
Entity Type:Individual
Prefix:DR
First Name:OCTAVIO
Middle Name:FEDERICO
Last Name:DELASOBERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 WEST 117TH. STREET
Mailing Address - Street 2:APT 7T
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-1577
Mailing Address - Country:US
Mailing Address - Phone:212-932-2797
Mailing Address - Fax:
Practice Address - Street 1:342 UNION AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1518
Practice Address - Country:US
Practice Address - Phone:201-933-4440
Practice Address - Fax:201-933-8159
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05963800208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation