Provider Demographics
NPI:1861689630
Name:MICHELLE E LIGGIO
Entity Type:Organization
Organization Name:MICHELLE E LIGGIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LIGGIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-665-9520
Mailing Address - Street 1:7665 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-3328
Mailing Address - Country:US
Mailing Address - Phone:856-665-9520
Mailing Address - Fax:856-665-6684
Practice Address - Street 1:7665 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3328
Practice Address - Country:US
Practice Address - Phone:856-665-9520
Practice Address - Fax:856-665-6684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB61420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6938205Medicaid
NJ6938205Medicaid
NJ872891U1WMedicare PIN