Healthcare Provider Details

I. General information

NPI: 1740289875
Provider Name (Legal Business Name): ANTHONY J SQUILLARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 JACK MARTIN BLVD STE A
BRICK NJ
08724-7737
US

IV. Provider business mailing address

525 JACK MARTIN BLVD STE A
BRICK NJ
08724-7737
US

V. Phone/Fax

Practice location:
  • Phone: 732-374-9217
  • Fax: 732-974-1246
Mailing address:
  • Phone: 732-374-9217
  • Fax: 732-974-1246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMA49021
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: