| Suburban Life Extension Institute Inc | |
|
2801 Morris Ave Union NJ 07083-4821 | |
| (908) 851-2500 | |
| (908) 851-0860 |
| Full Name | Suburban Life Extension Institute Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2801 Morris Ave, Union, New Jersey |
| Authorized Official Name and Position | William Arthur Digiacomo (PRESIDENT) |
| Authorized Official Contact | 9088512500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Suburban Life Extension Institute Inc 2801 Morris Ave Union NJ 07083-4821 Ph: (908) 851-2500 | Suburban Life Extension Institute Inc 2801 Morris Ave Union NJ 07083-4821 Ph: (908) 851-2500 |
| NPI Number | 1922150838 |
|---|---|
| Provider Enumeration Date | 01/18/2007 |
| Last Update Date | 01/10/2023 |
| Medicare PECOS PAC ID | 4183808538 |
|---|---|
| Medicare Enrollment ID | O20110408000129 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922150838 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | William A Digiacomo |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1184672172 PECOS PAC ID: 3173556545 Enrollment ID: I20050915000760 |
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