MEDICARE: DR. LEONARD RUSSELL DIPISA M.D.

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	MA37725	NJ
2	207R00000X	Internal Medicine Physician	25MA03772500	NJ
3	207RC0000X	Cardiovascular Disease Physician	25MA03772500	NJ
4	207UN0901X	Nuclear Cardiology Physician	25MA03772500	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D029592	OTHER	NJ	CDS
2	MA37725	OTHER	NJ	LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730176611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD RUSSELL DIPISA M.D.

Provider Business Mailing Address
First Line	:	780 RTE 37 W
Second Line	:	SUITE 310
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-5059
Country	:	US
Telephone Number	:	732-240-0599
Fax Number	:	732-240-3039

Provider Business Practice Location Address
First Line	:	780 RTE 37 W
Second Line	:	SUITE 310
City	:	TOMS RIVER
State	:	NJ
Zip	:	08755-5059
Country	:	US
Telephone Number	:	732-240-0599
Fax Number	:	732-240-3039

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	04/11/2024

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Directions to “ DR. LEONARD RUSSELL DIPISA M.D.” Practice Location

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