Healthcare Provider Details

I. General information

NPI: 1285633321
Provider Name (Legal Business Name): PETER D SCALIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 04/11/2025
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 HWY 138 BLDG #1 STE 102
WALL NJ
07719
US

IV. Provider business mailing address

1540 HWY 138 BLDG #1 STE 102
WALL NJ
07719
US

V. Phone/Fax

Practice location:
  • Phone: 848-208-2055
  • Fax: 848-208-2043
Mailing address:
  • Phone: 848-208-2055
  • Fax: 848-208-2043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMA45352
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: