Provider Demographics
NPI:1649218421
Name:DIGIACOMO, DENNIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
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: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
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03818900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1467598177OtherGROUP NPI
NJDD326AEOtherEMPIRE BC/BS
NJ2K9656OtherHEALTHNET
NJEP023OtherOXFORD
NJ2K9656OtherHEALTHNET
NJ160335UQ5Medicare PIN