1013903228 NPI number — LEONARD DIGIOVANNI

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013903228 NPI number — LEONARD DIGIOVANNI

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DIGIOVANNI

Provider First Name:

LEONARD

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1013903228

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/16/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

24 ELM ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

HARRINGTON PARK

Provider Business Mailing Address State Name:

NJ

Provider Business Mailing Address Postal Code:

07640-1902

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

201-784-0123

Provider Business Mailing Address Fax Number:

201-784-0065

Provider First Line Business Practice Location Address:

163 PARIS AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

NORTHVALE

Provider Business Practice Location Address State Name:

NJ

Provider Business Practice Location Address Postal Code:

07647-2028

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

201-768-9090

Provider Business Practice Location Address Fax Number:

201-768-9009

Provider Enumeration Date:

09/22/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 174400000X , with the licence number:  25MB01994700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0267503 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
• Identifier: 0D3122 . This is a "EMPIRE HC (TE) #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 1K5718 . This is a "HEALTHNET #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0048302000 . This is a "AMERIHEALTH #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 080167328 . This is a "RAILROAD MDCR #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 504268 . This is a "AETNA HMO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: BP502 . This is a "OXFORD #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0D3121 . This is a "EMPIRE HC (HP) #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 0D3123 . This is a "EMPIRE HC (NV) #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 4323770 . This is a "AETNA PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
• Identifier: 5999577 . This is a "GHI PPO #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".