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General NPI Number Information
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NPI Number | 1578586632
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Entity Type | Individual
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Provider Name | DANTE ANTHONY IMPLICITO M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 113 W ESSEX ST STE 201
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City | MAYWOOD
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State | NJ
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Zip | 07607-1023
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Country | US
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Telephone | 201-251-7725
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Fax | 201-251-2599
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Provider Business Mailing Address
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Address Line | 113 W ESSEX ST STE 201
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City | MAYWOOD
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State | NJ
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Zip | 07607-1023
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Country | US
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Telephone | 201-251-7725
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Fax | 201-251-2599
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | 25MA05651300
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License Number State | NJ
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