Provider Demographics
NPI:1356312508
Name:LANDOLFI, MICHAEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:LANDOLFI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:31 BIRCHWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NORTH HALEDON
Mailing Address - State:NJ
Mailing Address - Zip Code:07508-3139
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:567 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1540
Practice Address - Country:US
Practice Address - Phone:973-751-4500
Practice Address - Fax:973-751-3073
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB0749600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2K5880OtherHEALTH NET
NJ5703108OtherCIGNA
NJAMERIHEALTHOther2255955000
NJ2336686OtherUNITED HEALTHCARE
NJ471A6OtherWELL CHOICE
NJ223670968003OtherST BARNABUS
NJGHIOther0498408
NJ3324544OtherAETNA
NJOXFORDOtherP2967964
NJ223670968OtherHORIZON BLUR CROSS/BLUE S
NJ2938103Medicaid
NJ2938103Medicaid
NJ571185Medicare ID - Type Unspecified