Provider Demographics
NPI:1922075373
Name:DISCIGLIO, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:DISCIGLIO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 596
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:866-295-0041
Mailing Address - Fax:708-342-2517
Practice Address - Street 1:1300 RTE 35
Practice Address - Street 2:PLAZA II, SUITE 101-103
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3537
Practice Address - Country:US
Practice Address - Phone:732-531-6400
Practice Address - Fax:732-571-0223
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2013-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05007600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0576506Medicaid
NJF03111Medicare UPIN
NJ540703Medicare PIN