Healthcare Provider Details

I. General information

NPI: 1043430242
Provider Name (Legal Business Name): DIEGO M FIORENTINO DO FACP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTH NEW ROAD
ABSECON NJ
08201
US

IV. Provider business mailing address

PO BOX 876
ABSECON NJ
08201
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-2062
  • Fax: 609-641-4633
Mailing address:
  • Phone: 609-641-2062
  • Fax: 609-641-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMB069439
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMB050409
License Number StateNJ

VIII. Authorized Official

Name: DR. DIEGO MICHAEL FIORENTINO
Title or Position: DOCTOR
Credential: DO FACP
Phone: 609-641-2062