Provider Demographics
NPI:1730176611
Name:DIPISA, LEONARD RUSSELL (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:RUSSELL
Last Name:DIPISA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:780 RTE 37 W
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5059
Mailing Address - Country:US
Mailing Address - Phone:732-240-0599
Mailing Address - Fax:732-240-3039
Practice Address - Street 1:780 RTE 37 W
Practice Address - Street 2:SUITE 310
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5059
Practice Address - Country:US
Practice Address - Phone:732-240-0599
Practice Address - Fax:732-240-3039
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37725174400000X
NJ25MA03772500207R00000X, 207RC0000X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD029592OtherCDS
NJMA37725OtherLICENSE
NJ4812107Medicaid
NJD029592OtherCDS
NJ459130DLPMedicare ID - Type Unspecified
NJAD9354313OtherDEA