Organization
DIVAGNO INTERVENTIONAL CARDIOLOGY MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONARDO JOSEPH DIVAGNO MD (PRACTITIONER)
(201) 845-3535
Entity
Organization
Contact information
Practice address
218 STATE RT 17 N, SUITE 310, ROCHELLE PARK, NJ 07662-3399
(201) 845-3535
(201) 845-4040
Mailing address
218 STATE RT 17 N, SUITE 310, ROCHELLE PARK, NJ 07662-3399
(201) 845-3535
(201) 845-4040
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
MA69173
NJ
207RI0011X
Interventional Cardiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8750009
—
NJ
01
—
P2656071
OXFORD
—
Enumeration date
07/15/2006
Last updated
11/04/2008
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