Provider Demographics
NPI:1033309968
Name:DIVINE GRACE MEDICAL SERVICES
Entity Type:Organization
Organization Name:DIVINE GRACE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARCIANO
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-235-1772
Mailing Address - Street 1:159 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3135
Mailing Address - Country:US
Mailing Address - Phone:973-235-1772
Mailing Address - Fax:973-235-1774
Practice Address - Street 1:159 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3135
Practice Address - Country:US
Practice Address - Phone:973-235-1772
Practice Address - Fax:973-235-1774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089762Medicare PIN