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General NPI Number Information
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NPI Number | 1396360319
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Entity Type | Organization
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Legal Business Name | DR MICHAEL VASSALLO, INC
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 335 WYCKOFF AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-2237
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Country | US
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Telephone | 201-913-6088
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Fax |
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Provider Business Mailing Address
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Address Line | 335 WYCKOFF AVE
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City | WYCKOFF
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State | NJ
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Zip | 07481-2237
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Country | US
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Telephone | 201-913-6088
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL A VASSALLO
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Credential | DO
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Telephone | 201-913-6088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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