Provider Demographics
NPI:1063449551
Name:DIGIACOMO, JODY CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:CHRISTOPHER
Last Name:DIGIACOMO
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 1:1001 W MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2579
Mailing Address - Country:US
Mailing Address - Phone:732-845-5001
Mailing Address - Fax:732-303-0114
Practice Address - Street 1:1001 W MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2579
Practice Address - Country:US
Practice Address - Phone:732-845-5001
Practice Address - Fax:732-303-0114
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0539712086S0127X, 208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5164001Medicaid
NJF29459Medicare UPIN
NJ884791Medicare PIN