Healthcare Provider Details

I. General information

NPI: 1598772261
Provider Name (Legal Business Name): ANTHONY J DIGILIO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 GORDON RD
ESSEX FELLS NJ
07021-1622
US

IV. Provider business mailing address

116 GORDON RD
ESSEX FELLS NJ
07021-1622
US

V. Phone/Fax

Practice location:
  • Phone: 973-847-0102
  • Fax:
Mailing address:
  • Phone: 973-847-0102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA03060100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: