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General NPI Number Information
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NPI Number | 1588680110
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Entity Type | Organization
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Legal Business Name | DIVAGNO INTERVENTIONAL CARDIOLOGY MD PA
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 218 STATE RT 17 N SUITE 310
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3399
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Country | US
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Telephone | 201-845-3535
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Fax | 201-845-4040
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Provider Business Mailing Address
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Address Line | 218 STATE RT 17 N SUITE 310
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City | ROCHELLE PARK
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State | NJ
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Zip | 07662-3399
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Country | US
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Telephone | 201-845-3535
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Fax | 201-845-4040
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Authorized Official
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Title or Position | PRACTITIONER
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Name | LEONARDO JOSEPH DIVAGNO
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Credential | MD
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Telephone | 201-845-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MA69173
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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