Provider Demographics
NPI:1851994651
Name:DIMAGGIO, STEPHEN MATTHEW (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MATTHEW
Last Name:DIMAGGIO
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PARKVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3891
Mailing Address - Country:US
Mailing Address - Phone:732-786-8811
Mailing Address - Fax:
Practice Address - Street 1:55 US HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-3018
Practice Address - Country:US
Practice Address - Phone:732-294-5197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03887100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist