Provider Demographics
NPI:1043430242
Name:DIEGO M FIORENTINO DO FACP LLC
Entity Type:Organization
Organization Name:DIEGO M FIORENTINO DO FACP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FIORENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO FACP
Authorized Official - Phone:609-641-2062
Mailing Address - Street 1:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201
Mailing Address - Country:US
Mailing Address - Phone:609-641-2062
Mailing Address - Fax:609-641-4633
Practice Address - Street 1:200 SOUTH NEW ROAD
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201
Practice Address - Country:US
Practice Address - Phone:609-641-2062
Practice Address - Fax:609-641-4633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB050409207R00000X
NJMB069439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1106805Medicaid
NJ1106805Medicaid
E27342Medicare UPIN