Provider Demographics
NPI:1316921489
Name:DEREMIGIO, DAVID MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:DEREMIGIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18914
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07191-8914
Mailing Address - Country:US
Mailing Address - Phone:201-488-0066
Mailing Address - Fax:201-488-6769
Practice Address - Street 1:30 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1914
Practice Address - Country:US
Practice Address - Phone:201-488-0066
Practice Address - Fax:201-488-6769
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05865200207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F84654Medicare UPIN