Provider Demographics
NPI:1366443459
Name:MIGLIORI, VINCENT J (DPM)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:MIGLIORI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:54 BEY LEA RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2891
Mailing Address - Country:US
Mailing Address - Phone:732-505-9728
Mailing Address - Fax:732-505-9787
Practice Address - Street 1:638 LACEY RD
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2104
Practice Address - Country:US
Practice Address - Phone:609-693-3202
Practice Address - Fax:609-693-7865
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMD1436213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3269400Medicaid
NJ423782DNNMedicare ID - Type UnspecifiedPROVIDER ID #
NJ3269400Medicaid