Provider Demographics
NPI:1689785776
Name:ROGER DIRUGGIERO
Entity Type:Organization
Organization Name:ROGER DIRUGGIERO
Other - Org Name:MORRIS OMNI MED
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRUGGIERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-377-8776
Mailing Address - Street 1:131 COLUMBIA TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-2181
Mailing Address - Country:US
Mailing Address - Phone:973-377-8776
Mailing Address - Fax:973-822-2393
Practice Address - Street 1:131 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2181
Practice Address - Country:US
Practice Address - Phone:973-377-8776
Practice Address - Fax:973-822-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04297700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCB4221OtherRAILROAD MEDICARE, PALMETTO GBA
NJE54384Medicare UPIN
NJ528138Medicare PIN
NJ0796450001Medicare NSC