Provider Demographics
NPI:1467598177
Name:DENNIS DIGIACOMO MD LLC
Entity Type:Organization
Organization Name:DENNIS DIGIACOMO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-371-8960
Mailing Address - Street 1:PO BOX 387
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-0387
Mailing Address - Country:US
Mailing Address - Phone:973-371-8960
Mailing Address - Fax:973-371-8961
Practice Address - Street 1:1072 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07106-1516
Practice Address - Country:US
Practice Address - Phone:973-623-5309
Practice Address - Fax:973-399-8562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03818900174400000X
NJMA1029244174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2K9656OtherHEALTHNET
1649218421OtherINDIVIDUAL NPI
NJEP023OtherOXFORD
NJEP023OtherOXFORD
NJC61020Medicare UPIN
NJ095656Medicare ID - Type Unspecified