Provider Demographics
NPI:1619076411
Name:CERNIGLIA, SALVATORE JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:JOSEPH
Last Name:CERNIGLIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 W JIMMIE LEEDS RD STE 501
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9419
Mailing Address - Country:US
Mailing Address - Phone:609-568-5567
Mailing Address - Fax:609-568-5614
Practice Address - Street 1:76 W JIMMIE LEEDS RD STE 501
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9419
Practice Address - Country:US
Practice Address - Phone:609-568-5567
Practice Address - Fax:609-568-5614
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02391600207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1725301Medicaid
E65025Medicare UPIN
NJ052078Medicare ID - Type Unspecified