Provider Demographics
NPI:1558586677
Name:DIMEGLIO, LUCIANNA (NP)
Entity Type:Individual
Prefix:
First Name:LUCIANNA
Middle Name:
Last Name:DIMEGLIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 VERONICA AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-246-4882
Mailing Address - Fax:732-249-5633
Practice Address - Street 1:75 VERONICA AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-246-4882
Practice Address - Fax:732-249-5633
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN09008800207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00176200OtherCDS
NJ8429405Medicaid
NJ1558586677OtherINDIVIDUAL NPI
NJ1265623169OtherGROUP NPI
NJ1265623169OtherGROUP NPI
NJ1558586677OtherINDIVIDUAL NPI
Q31031Medicare UPIN