Provider Demographics
NPI:1336170216
Name:DEMESMIN, DIDIER A (MD)
Entity Type:Individual
Prefix:DR
First Name:DIDIER
Middle Name:A
Last Name:DEMESMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 VERONICA AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-3448
Mailing Address - Country:US
Mailing Address - Phone:732-873-6868
Mailing Address - Fax:732-873-6869
Practice Address - Street 1:59 VERONICA AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3448
Practice Address - Country:US
Practice Address - Phone:732-873-6868
Practice Address - Fax:732-873-6869
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07892100208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ091620Medicare ID - Type Unspecified
NJI31080Medicare UPIN