MEDICARE: JOSEPH A. DIGIOVANNA & MICHAEL J. DIGIOVANNA,D.O.,P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	1753621	NY

General Provider Information

NPI Number	:	1063424851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH A. DIGIOVANNA & MICHAEL J. DIGIOVANNA,D.O.,P.C.

Provider Business Mailing Address
First Line	:	1061 N BROADWAY
Second Line	:
City	:	NORTH MASSAPEQUA
State	:	NY
Zip	:	11758-1802
Country	:	US
Telephone Number	:	516-420-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 N BROADWAY
Second Line	:
City	:	NORTH MASSAPEQUA
State	:	NY
Zip	:	11758-1802
Country	:	US
Telephone Number	:	516-420-4300
Fax Number	:	516-420-0730

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL JOSEPH DIGIOVANNA
Credential	:	D.O.
Telephone Number	:	516-420-4300

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	08/22/2020

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