MEDICARE: ELAINE K DIEGMANN CNM

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	367A00000X	Advanced Practice Midwife	25M00002001	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407817166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELAINE K DIEGMANN CNM

Provider Business Mailing Address
First Line	:	95 OLD SHORT HILLS RD
Second Line	:
City	:	WEST ORANGE
State	:	NJ
Zip	:	07052-1008
Country	:	US
Telephone Number	:	973-322-4390
Fax Number	:	973-324-5227

Provider Business Practice Location Address
First Line	:	65 BERGEN ST
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-3001
Country	:	US
Telephone Number	:	973-972-4298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	02/17/2015

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