Provider Demographics
NPI:1093118366
Name:DIANE MARCHESANI, DO LLC
Entity Type:Organization
Organization Name:DIANE MARCHESANI, DO LLC
Other - Org Name:DIANE MARCHESANI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCHESANI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:609-652-2240
Mailing Address - Street 1:PO BOX 738
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NJ
Mailing Address - Zip Code:08240-0738
Mailing Address - Country:US
Mailing Address - Phone:609-652-2240
Mailing Address - Fax:
Practice Address - Street 1:72 W JIMMIE LEEDS RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9406
Practice Address - Country:US
Practice Address - Phone:609-652-2240
Practice Address - Fax:609-652-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08287700207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ375463Medicare PIN