Provider Demographics
NPI:1851336671
Name:CARFAGNO, SALVATORE A JR (DO)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:A
Last Name:CARFAGNO
Suffix:JR
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 1:707 WHITE HORSE PIKE
Mailing Address - Street 2:SUITE D4
Mailing Address - City:ABSECON
Mailing Address - State:NJ
Mailing Address - Zip Code:08201
Mailing Address - Country:US
Mailing Address - Phone:609-927-9495
Mailing Address - Fax:609-927-7328
Practice Address - Street 1:707 WHITE HORSE PIKE
Practice Address - Street 2:SUITE D4
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201
Practice Address - Country:US
Practice Address - Phone:609-272-0506
Practice Address - Fax:609-272-0607
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06505000207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8236208Medicaid
H18462Medicare UPIN
NJ8236208Medicaid