MEDICARE: ROBERT MICHAEL DISOGRA AU.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	237600000X	Audiologist-Hearing Aid Fitter	YA00017	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	:	1902806029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MICHAEL DISOGRA AU.D.

Provider Business Mailing Address
First Line	:	14 PLAZA DE LAS TRINIDAD
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-5277
Country	:	US
Telephone Number	:	732-625-8238
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 PLAZA DE LAS TRINIDAD
Second Line	:
City	:	FREEHOLD
State	:	NJ
Zip	:	07728-5277
Country	:	US
Telephone Number	:	732-625-8238
Fax Number	:

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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