Provider Demographics
NPI:1467486365
Name:MICALLEF, DONALD M (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:M
Last Name:MICALLEF
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 1:512 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07762-1233
Mailing Address - Country:US
Mailing Address - Phone:732-449-0063
Mailing Address - Fax:732-449-7073
Practice Address - Street 1:512 WARREN AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1233
Practice Address - Country:US
Practice Address - Phone:732-449-0063
Practice Address - Fax:732-449-7073
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ630415Medicare PIN