Healthcare Provider Details

I. General information

NPI: 1427234772
Provider Name (Legal Business Name): BIAGIO COMO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CORNWALL DR
EAST BRUNSWICK NJ
08816-3311
US

IV. Provider business mailing address

3 CORNWALL DR
EAST BRUNSWICK NJ
08816-3311
US

V. Phone/Fax

Practice location:
  • Phone: 732-698-1000
  • Fax: 732-698-1008
Mailing address:
  • Phone: 732-698-1000
  • Fax: 732-698-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011205
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: