Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | MA053971 | NJ |
Y | 208600000X | Surgeon | MA053971 | NJ |
N | 2086S0102X | Surgical Critical Care | MA053971 | NJ |
N | 2086S0127X | Trauma Surgeon | MA053971 | NJ |
NPI | 1063449551 |
---|---|
Provider Name | Jody Christopher Digiacomo |
First Address | Freehold, NJ 07728-2579 |
Second Address | Freehold, NJ 07728-2579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 25/03/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5164001 | (05) | NJ |
F29459 | (02) | NJ |