Provider Demographics
NPI:1912289059
Name:DONALD M MICALLEF MD PC
Entity Type:Organization
Organization Name:DONALD M MICALLEF MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:MICALLEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-449-0063
Mailing Address - Street 1:184 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2056
Mailing Address - Country:US
Mailing Address - Phone:732-449-0063
Mailing Address - Fax:732-449-3427
Practice Address - Street 1:512 WARREN AVE
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-1233
Practice Address - Country:US
Practice Address - Phone:732-449-0063
Practice Address - Fax:732-449-3427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ630415Medicare PIN
NJE82700Medicare UPIN