Provider Demographics
NPI:1770583098
Name:MORREALE, DIEGO A (MD)
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:A
Last Name:MORREALE
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 1:225 NEWTONS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-8818
Mailing Address - Country:US
Mailing Address - Phone:732-458-9760
Mailing Address - Fax:
Practice Address - Street 1:225 NEWTONS CORNER RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-8818
Practice Address - Country:US
Practice Address - Phone:732-458-9760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08225900207R00000X
CT042847207R00000X
NY234453207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001428475Medicaid
CT042847OtherCONNECTICARE HMO
CT7251638OtherAETNA
CTI26888Medicare UPIN
CT7251638OtherAETNA