Healthcare Provider Details

I. General information

NPI: 1104897388
Provider Name (Legal Business Name): LUCA DESIMONE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 LINCOLN HWY STE 410
EDISON NJ
08820-3961
US

IV. Provider business mailing address

2 LINCOLN HWY STE 410
EDISON NJ
08820-3961
US

V. Phone/Fax

Practice location:
  • Phone: 908-834-8030
  • Fax: 908-834-8033
Mailing address:
  • Phone: 908-834-8030
  • Fax: 908-834-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07410900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA07410900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: