Provider Demographics
NPI:1659779601
Name:SPITALIERI, SALVATORE JR (ATC)
Entity Type:Individual
Prefix:MR
First Name:SALVATORE
Middle Name:
Last Name:SPITALIERI
Suffix:JR
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 MAPLE LEAF DR
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-1934
Mailing Address - Country:US
Mailing Address - Phone:609-457-2153
Mailing Address - Fax:
Practice Address - Street 1:414 TATUM ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3499
Practice Address - Country:US
Practice Address - Phone:856-848-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-08
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT001567002255A2300X
PART0051462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer