Healthcare Provider Details

I. General information

NPI: 1659552495
Provider Name (Legal Business Name): SALVATORE MIGLIORISI B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8910 JAMAICA AVE
WOODHAVEN NY
11421-2040
US

IV. Provider business mailing address

187 LARCH AVE
TEANECK NJ
07666-2307
US

V. Phone/Fax

Practice location:
  • Phone: 718-849-7777
  • Fax:
Mailing address:
  • Phone: 201-357-5168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number32635
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: