Provider Demographics
NPI:1225076235
Name:DIVINO, EUMENA
Entity Type:Individual
Prefix:
First Name:EUMENA
Middle Name:
Last Name:DIVINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48270
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4800
Mailing Address - Country:US
Mailing Address - Phone:201-818-9118
Mailing Address - Fax:
Practice Address - Street 1:390 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:FORDS
Practice Address - State:NJ
Practice Address - Zip Code:08863-2110
Practice Address - Country:US
Practice Address - Phone:732-738-4260
Practice Address - Fax:732-738-5693
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02674500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1108112OtherAETNA HMO #
NJP3618222OtherOXFORD #
NJ2K9373OtherHEALTHNET #
NJ805E92OtherEMPIRE BCBS (FORDS)
NJ0102820000OtherAMERIHEALTH #
NJ0296220OtherGHI PPO #
NJ4272415OtherAETNA PPO #
NJ805E91OtherEMPIRE BCBS (PERTH AMBOY)
NJ4272415OtherAETNA PPO #
NJ805E92OtherEMPIRE BCBS (FORDS)