Healthcare Provider Details

I. General information

NPI: 1750554531
Provider Name (Legal Business Name): ERNEST JOSEPH DESALVO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

7 NORMAN RD
UPPER MONTCLAIR NJ
07043-1933
US

IV. Provider business mailing address

7 NORMAN RD
UPPER MONTCLAIR NJ
07043-1933
US

V. Phone/Fax

Practice location:
  • Phone: 973-746-3181
  • Fax:
Mailing address:
  • Phone: 973-746-3181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number25MA02291000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: