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General NPI Number Information
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NPI Number | 1457022329
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Entity Type | Individual
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Provider Name | SALVATORE J FOGARINO III DPT
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Gender | Male
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Dates
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Enumeration Date | 09/21/2021
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 570 EGG HARBOR RD STE C-4C
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City | SEWELL
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State | NJ
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Zip | 08080-2359
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Country | US
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Telephone | 609-267-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 301 LIPPINCOTT DR STE 410
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City | MARLTON
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State | NJ
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Zip | 08053-4197
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Country | US
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Telephone | 856-355-0340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 2305214700
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | PT5000023
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 40QA02162000
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License Number State | NJ
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