Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 ROUTE 9 N SUITE 302
WOODBRIDGE NJ
07095-1215
US

IV. Provider business mailing address

1000 ROUTE 9 N SUITE 302
WOODBRIDGE NJ
07095-1215
US

V. Phone/Fax

Practice location:
  • Phone: 732-634-0036
  • Fax: 732-855-9395
Mailing address:
  • Phone: 732-634-0036
  • Fax: 732-855-9395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA74109
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMA74109
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: