Provider Demographics
NPI:1770689077
Name:DIMEO, ALEXANDER (RPH DC)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:DIMEO
Suffix:
Gender:M
Credentials:RPH DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CROMWELL DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2153
Mailing Address - Country:US
Mailing Address - Phone:973-670-6897
Mailing Address - Fax:908-879-2744
Practice Address - Street 1:647 MAIN AVE
Practice Address - Street 2:STE 202
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-4934
Practice Address - Country:US
Practice Address - Phone:973-777-5400
Practice Address - Fax:973-777-5445
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28 RI01498300183500000X
NJ38MC00301100111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT45177Medicare UPIN
NJ451089SLFMedicare ID - Type Unspecified