Individual
BRETT CERNIGLIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, MPH
Contact information
Practice address
44 E JIMMIE LEEDS RD STE 101, GALLOWAY, NJ 08205-9599
(609) 677-9729
Mailing address
915 S 11TH ST, APT# 1A, PHILADELPHIA, PA 19147-3701
(518) 496-6829
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT206281
PA
2085R0202X
Diagnostic Radiology Physician
Primary
25MA10769700
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1E2984
MEDICARE
NJ
01
—
25MA10769700
STATE MEDICAL LICENSE
NJ
Enumeration date
06/04/2014
Last updated
06/24/2021
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