Provider Demographics
NPI:1457301699
Name:DIRUGGIERO, ROGER PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PHILIP
Last Name:DIRUGGIERO
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 1:9 WILDLIFE RUN
Mailing Address - Street 2:
Mailing Address - City:NEW VERNON
Mailing Address - State:NJ
Mailing Address - Zip Code:07976-9720
Mailing Address - Country:US
Mailing Address - Phone:973-945-4246
Mailing Address - Fax:
Practice Address - Street 1:271 GROVE AVE STE A
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-1731
Practice Address - Country:US
Practice Address - Phone:973-239-2600
Practice Address - Fax:833-495-1920
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04297700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110045533OtherRAILROAD MEDICARE, PALMETTO GBA
NJ467460B0VMedicare ID - Type Unspecified
NJ110045533OtherRAILROAD MEDICARE, PALMETTO GBA