Individual
MICHAEL ANGELO IETTA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 W MAIN ST, SUITE 16, WYCKOFF, NJ 07481-1439
(201) 847-9403
(201) 847-0059
Mailing address
71 GILBERT RD, HO HO KUS, NJ 07423-1405
(201) 251-2213
(201) 251-2279
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MA56733
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5508207
—
NJ
Enumeration date
03/10/2006
Last updated
07/08/2007
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