Stephan Digiacomo, DPT | |
717 N Beers St Ste 1e, Holmdel, NJ 07733-1525 | |
(732) 344-2192 | |
Not Available |
Full Name | Stephan Digiacomo |
---|---|
Gender | Male |
Speciality | Physical Therapist |
Location | 717 N Beers St Ste 1e, Holmdel, New Jersey |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1073223335 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
225100000X | Physical Therapist | 047420 (New York) | Primary |
225100000X | Physical Therapist | 40QA02019000 (New Jersey) | Secondary |
Provider Name | Ivyrehab Physical Therapy Pllc |
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Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1396799409 PECOS PAC ID: 7012997638 Enrollment ID: O20040723000705 |
Mailing Address | Practice Location Address |
---|---|
Stephan Digiacomo, DPT 717 N Beers St Ste 1e, Holmdel, NJ 07733-1525 Ph: (732) 344-2192 | Stephan Digiacomo, DPT 717 N Beers St Ste 1e, Holmdel, NJ 07733-1525 Ph: (732) 344-2192 |
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