Provider Demographics
NPI:1437280336
Name:SCALIA, IGNATIUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:IGNATIUS
Middle Name:
Last Name:SCALIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:869 BERGEN AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4405
Mailing Address - Country:US
Mailing Address - Phone:201-333-4990
Mailing Address - Fax:201-332-7650
Practice Address - Street 1:869 BERGEN AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4405
Practice Address - Country:US
Practice Address - Phone:201-333-4990
Practice Address - Fax:201-332-7650
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016993001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6437702Medicaid
NJ708660OtherAETNA ID NUMBER
NJ708660OtherAETNA ID NUMBER
NJU54849Medicare UPIN