Individual
DR. LEONARD RUSSELL DIPISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
780 RTE 37 W, SUITE 310, TOMS RIVER, NJ 08755-5059
(732) 240-0599
(732) 240-3039
Mailing address
780 RTE 37 W, SUITE 310, TOMS RIVER, NJ 08755-5059
(732) 240-0599
(732) 240-3039
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MA37725
NJ
207R00000X
Internal Medicine Physician
25MA03772500
NJ
207RC0000X
Cardiovascular Disease Physician
25MA03772500
NJ
207UN0901X
Nuclear Cardiology Physician
Primary
25MA03772500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4812107
—
NJ
01
—
D029592
CDS
NJ
01
—
MA37725
LICENSE
NJ
Enumeration date
10/05/2005
Last updated
04/11/2024
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