Provider Demographics
NPI:1285633321
Name:SCALIA, PETER D (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:D
Last Name:SCALIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 INDUSTRIAL WAY W STE 103
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-4244
Mailing Address - Country:US
Mailing Address - Phone:848-208-2055
Mailing Address - Fax:732-988-7852
Practice Address - Street 1:234 INDUSTRIAL WAY W STE 103
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-4244
Practice Address - Country:US
Practice Address - Phone:848-208-2055
Practice Address - Fax:848-208-2078
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA45352208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5069602Medicaid
681300CBMedicare ID - Type Unspecified
NJ5069602Medicaid
681300CBMedicare PIN