Individual
DIANA R. DECOSIMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
90 BERGEN ST, DOC 4400, NEWARK, NJ 07103-2425
(973) 972-1880
(973) 972-1879
Mailing address
30 BERGEN ST, ADMC 12 1205, NEWARK, NJ 07107-3000
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
25MA06131700
NJ
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
25MA06131700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6326200
—
NJ
Enumeration date
07/11/2006
Last updated
08/27/2009
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