Provider Demographics
NPI:1013903228
Name:DIGIOVANNI, LEONARD
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:DIGIOVANNI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1902
Mailing Address - Country:US
Mailing Address - Phone:201-784-0123
Mailing Address - Fax:201-784-0065
Practice Address - Street 1:163 PARIS AVE
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-2028
Practice Address - Country:US
Practice Address - Phone:201-768-9090
Practice Address - Fax:201-768-9009
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB01994700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0267503Medicaid
NJ0D3122OtherEMPIRE HC (TE) #
NJ1K5718OtherHEALTHNET #
NJ0048302000OtherAMERIHEALTH #
NJ080167328OtherRAILROAD MDCR #
NJ504268OtherAETNA HMO #
NJBP502OtherOXFORD #
NJ0D3121OtherEMPIRE HC (HP) #
NJ0D3123OtherEMPIRE HC (NV) #
NJ4323770OtherAETNA PPO #
NJ5999577OtherGHI PPO #
NJ080167328OtherRAILROAD MDCR #
NJ440222C3JMedicare PIN