Healthcare Provider Details

I. General information

NPI: 1770298887
Provider Name (Legal Business Name): MICHAEL DIGANGI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 METRO BLVD
NUTLEY NJ
07110-6101
US

IV. Provider business mailing address

45 ROCKWELL CIR
MARLBORO NJ
07746-1158
US

V. Phone/Fax

Practice location:
  • Phone: 973-275-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: