Healthcare Provider Details

I. General information

NPI: 1710020078
Provider Name (Legal Business Name): ALBERT MAGALIO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FOOTBRIDGE LN
BLAIRSTOWN NJ
07825-2512
US

IV. Provider business mailing address

PO BOX U
BLAIRSTOWN NJ
07825-0980
US

V. Phone/Fax

Practice location:
  • Phone: 908-362-5090
  • Fax: 908-362-5780
Mailing address:
  • Phone: 908-362-5090
  • Fax: 908-362-5780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDI 17822
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: