MEDICARE: DR. MICHAEL VASSALLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	25MB05947200	NJ

General Provider Information

NPI Number	:	1093729204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL VASSALLO

Provider Business Mailing Address
First Line	:	40 STIRLING RD
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-5900
Country	:	US
Telephone Number	:	908-769-0912
Fax Number	:

Provider Business Practice Location Address
First Line	:	40 STIRLING RD
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-5900
Country	:	US
Telephone Number	:	908-769-0912
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	07/08/2007

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