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General NPI Number Information
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NPI Number | 1467598177
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Entity Type | Organization
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Legal Business Name | DENNIS DIGIACOMO MD LLC
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 09/14/2007
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Provider Practice Location Address
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Address Line | 1072 S ORANGE AVE
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City | NEWARK
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State | NJ
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Zip | 07106-1516
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Country | US
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Telephone | 973-623-5309
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Fax | 973-399-8562
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Provider Business Mailing Address
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Address Line | PO BOX 387
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City | SOUTH ORANGE
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State | NJ
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Zip | 07079-0387
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Country | US
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Telephone | 973-371-8960
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Fax | 973-371-8961
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. APRIL MCCARTHY
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Credential |
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Telephone | 973-371-8960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MA1029244
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA03818900
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License Number State | NJ
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