Organization
DR MICHAEL VASSALLO, INC
Active
Other names
Dr. MICHAEL A VASSALLO
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL A VASSALLO DO (OWNER)
(201) 913-6088
Entity
Organization
Contact information
Practice address
335 WYCKOFF AVE, WYCKOFF, NJ 07481-2237
(201) 913-6088
Mailing address
335 WYCKOFF AVE, WYCKOFF, NJ 07481-2237
(201) 913-6088
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25-MB059472-00
MEDICAL LICENSE
NJ
Enumeration date
06/15/2020
Last updated
06/15/2020
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