MEDICARE: DR. ERNEST JOSEPH DESALVO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	25MA02291000	NJ

General Provider Information

NPI Number	:	1750554531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERNEST JOSEPH DESALVO M.D.

Provider Business Mailing Address
First Line	:	7 NORMAN RD
Second Line	:
City	:	UPPER MONTCLAIR
State	:	NJ
Zip	:	07043-1933
Country	:	US
Telephone Number	:	973-746-3181
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 NORMAN RD
Second Line	:
City	:	UPPER MONTCLAIR
State	:	NJ
Zip	:	07043-1933
Country	:	US
Telephone Number	:	973-746-3181
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2008
Last Update Date	:	04/11/2008

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