Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | MA59584 | NJ |
N | 207RI0011X | Interventional Cardiology | MA59584 | NJ |
NPI | 1023086691 |
---|---|
Provider Name | Joseph Degregorio |
First Address | Glen Ridge, NJ 07028 |
Second Address | Glen Ridge, NJ 07028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 24/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7702507 | (05) | NJ |
G79319 | (02) |