Diverse Medical LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

DIVERSE MEDICAL LLC

Practice address

515 Valley St
Suite 5
Maplewood, NJ 07040-1388

Phone

(973) 327-2471

Fax

(973) 327-2483

NPI assigned

Jan 6, 2011

Last updated

Jan 24, 2017By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Marilu CoscolluelaNPI 1801060579

Title

Owner

Phone

(973) 325-5768

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Marilu D Coscolluela, PT

  • Physical Therapist
  • West Orange, NJ
  • NPI 1801060579
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1710281688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 VALLEY ST",
            "address_2": "SUITE 5",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070401388",
            "telephone_number": "973-327-2471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 VALLEY ST",
            "address_2": "SUITE 5",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070401388",
            "telephone_number": "973-327-2471",
            "fax_number": "973-327-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVERSE MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-06",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "COSCOLLUELA",
        "authorized_official_first_name": "MARILU",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "973-325-5768",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Deperi, R.N.
• Richard Owen Dewald, RN
• Stella Diai
• Joseph Dias, PTA
• Leon Sherman Dick, M.D.
• Lesley Ann Dixon, LCSW
• Tanisha Dixon
• Clea Dobrish, LSW
• Elizabeth Dobrish, LCSW
• Sashi Deep Dondapati, RPH

• Prosthetic/Orthotic Supplier in Maplewood, NJ
• Providers in Maplewood, NJ by specialty
• Prosthetic/Orthotic Supplier in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.