Provider Demographics
NPI:1659552495
Name:MIGLIORISI, SALVATORE (BS)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:MIGLIORISI
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 LARCH AVE
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2307
Mailing Address - Country:US
Mailing Address - Phone:201-357-5168
Mailing Address - Fax:
Practice Address - Street 1:8910 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2040
Practice Address - Country:US
Practice Address - Phone:718-849-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32635183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist