Provider Demographics
NPI:1710973243
Name:MIGLIETTA, MAURIZIO A (DO)
Entity Type:Individual
Prefix:DR
First Name:MAURIZIO
Middle Name:A
Last Name:MIGLIETTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 PARK AVE APT 2903
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-3779
Mailing Address - Country:US
Mailing Address - Phone:888-320-0922
Mailing Address - Fax:888-909-4197
Practice Address - Street 1:222 CEDAR LN STE 201
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4312
Practice Address - Country:US
Practice Address - Phone:888-320-0922
Practice Address - Fax:888-909-4197
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB670182086S0127X
NY2257202086S0102X
NJ25MB0670800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7648707Medicaid
NY0233768Medicaid
NY0233768Medicaid
NJ7648707Medicaid