Decosimo, Diana R.

Decosimo, Diana R. is an individual health care provider with primary practice located at 90 Bergen St Doc 4400, Newark NJ 07103-2425. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Geriatric Medicine. Allopathic & Osteopathic Physicians / Geriatric Medicine is her primary health care specialty. Decosimo, Diana R. can be contacted via phone (973) 972-1880.

Contact Information

Primary practice address
90 Bergen St Doc 4400 Newark NJ 07103-2425
Phone: (973) 972-1880
Fax: (973) 972-1879
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 25MA06131700 New Jersey
Allopathic & Osteopathic Physicians / Geriatric Medicine 207RG0300X 25MA06131700 New Jersey

Profile Details

NPI number 1962437731
LBN Legal business name Decosimo, Diana R.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Aug 27th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962437731 NPPES
New Jersey MEDICAID 6326200

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