Healthcare Provider Details

I. General information

NPI: 1730352576
Provider Name (Legal Business Name): ALVIN FRANCIS MICABALO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 ROUTE 27
EDISON NJ
08820-3986
US

IV. Provider business mailing address

72 ROUTE 27
EDISON NJ
08820-3986
US

V. Phone/Fax

Practice location:
  • Phone: 732-662-9901
  • Fax: 732-662-9904
Mailing address:
  • Phone: 732-662-9901
  • Fax: 732-662-9904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB08243000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number25MB08243000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: