Healthcare Provider Details

I. General information

NPI: 1275588196
Provider Name (Legal Business Name): DOMINIC A. DIORIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 09/28/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CRUMP LN
MERCHANTVILLE NJ
08109-2624
US

IV. Provider business mailing address

6 CRUMP LN
MERCHANTVILLE NJ
08109-2624
US

V. Phone/Fax

Practice location:
  • Phone: 609-364-6901
  • Fax: 856-488-0291
Mailing address:
  • Phone: 609-364-6901
  • Fax: 856-488-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMA22911
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: