Healthcare Provider Details

I. General information

NPI: 1366439192
Provider Name (Legal Business Name): DOMENICO SAVATTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ETHEL RD STE 103B
EDISON NJ
08817-2838
US

IV. Provider business mailing address

1 ETHEL RD STE 103B
EDISON NJ
08817-2838
US

V. Phone/Fax

Practice location:
  • Phone: 732-395-7488
  • Fax: 908-364-5379
Mailing address:
  • Phone: 732-395-7488
  • Fax: 908-364-5379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number25MA07571500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: