Provider Demographics
NPI:1093765307
Name:SCIURBA, SALVATORE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:SCIURBA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BARR HARBOR DR, FOUR TOWER BRIDGE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-4979
Mailing Address - Country:US
Mailing Address - Phone:848-240-2812
Mailing Address - Fax:732-731-6135
Practice Address - Street 1:1000 ROUTE 35 STE 200
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2606
Practice Address - Country:US
Practice Address - Phone:800-337-6663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00131900207N00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7149264OtherAETNA HMO
NJ9301227OtherAETNA PPO
NJ3K5461OtherHEALTHNET
NJ320517OtherAMERICAID/AMERIGROUP
NJ106454C2HMedicare PIN
NJ3K5461OtherHEALTHNET
NJ7149264OtherAETNA HMO