Provider Demographics
NPI:1134333933
Name:MARI DIPASQUALE, DO LLC
Entity type:Organization
Organization Name:MARI DIPASQUALE, DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:
Authorized Official - Last Name:DIPASQUALE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-339-9886
Mailing Address - Street 1:764 EASTON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1856
Mailing Address - Country:US
Mailing Address - Phone:732-339-9886
Mailing Address - Fax:732-937-8081
Practice Address - Street 1:764 EASTON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1856
Practice Address - Country:US
Practice Address - Phone:732-339-9886
Practice Address - Fax:732-937-8081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB053223002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457405979OtherINDIVIDUAL NPI #
1457405979OtherINDIVIDUAL NPI #
NJ110300Medicare ID - Type UnspecifiedMEDICARE GROUP ID
F93434Medicare UPIN