Healthcare Provider Details

I. General information

NPI: 1407244437
Provider Name (Legal Business Name): EDGE SURGICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 MCGRATH DR
CRESSKILL NJ
07626-1745
US

IV. Provider business mailing address

36 MCGRATH DR
CRESSKILL NJ
07626-1745
US

V. Phone/Fax

Practice location:
  • Phone: 201-280-6150
  • Fax: 888-909-4197
Mailing address:
  • Phone: 201-280-6150
  • Fax: 888-909-4197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMB067108
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAURIZIO MIGLIETTA
Title or Position: PRESIDENT
Credential: D.O.
Phone: 201-280-6150