Provider Demographics
NPI:1427098268
Name:DESIMONE, EUGENE M (MD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:M
Last Name:DESIMONE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:REGENOMED LLC - EUGENE DESIMONE MD
Mailing Address - Street 2:1806 HWY 35 SUITE 205A
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-2700
Mailing Address - Country:US
Mailing Address - Phone:201-803-3986
Mailing Address - Fax:201-348-0026
Practice Address - Street 1:REGENOMED LLC - EUGENE DESIMONE MD
Practice Address - Street 2:1806 HWY 35 SUITE 205A
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2700
Practice Address - Country:US
Practice Address - Phone:201-803-3986
Practice Address - Fax:201-348-0026
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2020-09-16
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA04251200207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56929Medicare UPIN
NJ536619Medicare ID - Type Unspecified