Provider Demographics
NPI:1457414120
Name:DIOMEDE, JOHN (RPH, PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:DIOMEDE
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WEBB CT
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-2426
Mailing Address - Country:US
Mailing Address - Phone:551-404-3750
Mailing Address - Fax:201-573-8785
Practice Address - Street 1:10 WEBB CT
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07656-2426
Practice Address - Country:US
Practice Address - Phone:551-404-3750
Practice Address - Fax:201-573-8785
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO1664300183500000X, 1835N1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist
Not Answered1835N1003XPharmacy Service ProvidersPharmacistNutrition Support