MEDICARE: DENNIS DIGIACOMO MD LLC

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	174400000X	Specialist	MA1029244	NJ
2	174400000X	Specialist	25MA03818900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2K9656	OTHER	NJ	HEALTHNET
2	1649218421	OTHER		INDIVIDUAL NPI
3	EP023	OTHER	NJ	OXFORD

General Provider Information

NPI Number	:	1467598177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS DIGIACOMO MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 387
Second Line	:
City	:	SOUTH ORANGE
State	:	NJ
Zip	:	07079-0387
Country	:	US
Telephone Number	:	973-371-8960
Fax Number	:	973-371-8961

Provider Business Practice Location Address
First Line	:	1072 S ORANGE AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07106-1516
Country	:	US
Telephone Number	:	973-623-5309
Fax Number	:	973-399-8562

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. APRIL MCCARTHY
Credential	:
Telephone Number	:	973-371-8960

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	09/14/2007

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