Healthcare Provider Details

I. General information

NPI: 1154361079
Provider Name (Legal Business Name): BRUCE DAVID CALLIGARO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 HAMBURG TURNPIKE SUITE 204
WAYNE NJ
07470-2160
US

IV. Provider business mailing address

426 HAMBURG TURNPIKE SUITE 204
WAYNE NJ
07470-2160
US

V. Phone/Fax

Practice location:
  • Phone: 973-595-8900
  • Fax: 973-595-0330
Mailing address:
  • Phone: 973-595-8900
  • Fax: 973-595-0330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberNJ1081
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: