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Organization
DIVERGE HEALTH IPA OF NY LLC
Active
Organization
DIVERGE HEALTH IPA OF NY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT PANTONE MD (CMO)
(941) 917-9000
Entity
Organization
Contact information
Practice address
500 ADAMS AVE, GLENCOE, IL 60022-1865
(941) 718-9000
Mailing address
500 ADAMS AVE, GLENCOE, IL 60022-1865
(941) 718-9000
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
03/08/2024
Last updated
04/08/2024
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