Healthcare Provider Details

I. General information

NPI: 1205771417
Provider Name (Legal Business Name): NAVALLO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SKILES AVE # 223
PISCATAWAY NJ
08854-4728
US

IV. Provider business mailing address

3 SKILES AVE # 223
PISCATAWAY NJ
08854-4728
US

V. Phone/Fax

Practice location:
  • Phone: 908-739-6534
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAUREN NAVALLO
Title or Position: MEMBER
Credential:
Phone: 908-739-6534