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General NPI Number Information
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NPI Number | 1730176611
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Entity Type | Individual
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Provider Name | LEONARD RUSSELL DIPISA M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/05/2005
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Last Update Date | 04/11/2024
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Provider Practice Location Address
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Address Line | 780 RTE 37 W SUITE 310
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City | TOMS RIVER
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State | NJ
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Zip | 08755-5059
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Country | US
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Telephone | 732-240-0599
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Fax | 732-240-3039
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Provider Business Mailing Address
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Address Line | 780 RTE 37 W SUITE 310
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City | TOMS RIVER
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State | NJ
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Zip | 08755-5059
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Country | US
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Telephone | 732-240-0599
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Fax | 732-240-3039
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA37725
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA03772500
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA03772500
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 207UN0901X
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Taxonomy Name | Nuclear Cardiology Physician
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License Number | 25MA03772500
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License Number State | NJ
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