Provider Demographics
NPI:1104047901
Name:J C DIGIACOMO, MD., LLC
Entity type:Organization
Organization Name:J C DIGIACOMO, MD., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:JODY
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIGIACOMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-683-0888
Mailing Address - Street 1:900 W MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2523
Mailing Address - Country:US
Mailing Address - Phone:732-303-9584
Mailing Address - Fax:732-294-1940
Practice Address - Street 1:900 W MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2523
Practice Address - Country:US
Practice Address - Phone:732-303-9584
Practice Address - Fax:732-294-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM25MA05397100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5164001Medicaid
NJF29459Medicare UPIN
NJ884791Medicare PIN