Provider Demographics
NPI:1063424851
Name:JOSEPH A. DIGIOVANNA & MICHAEL J. DIGIOVANNA,D.O.,P.C.
Entity type:Organization
Organization Name:JOSEPH A. DIGIOVANNA & MICHAEL J. DIGIOVANNA,D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DIGIOVANNA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-420-4300
Mailing Address - Street 1:1061 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1802
Mailing Address - Country:US
Mailing Address - Phone:516-420-4300
Mailing Address - Fax:
Practice Address - Street 1:1061 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1802
Practice Address - Country:US
Practice Address - Phone:516-420-4300
Practice Address - Fax:516-420-0730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1753621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty