Ietta, Michael Angelo

Ietta, Michael Angelo is an individual health care provider with primary practice located at 500 W Main St Suite 16, Wyckoff NJ 07481-1439. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anesthesiology, which is considered as his primary health care specialty. Ietta, Michael Angelo can be contacted via phone (201) 847-9403.

Contact Information

Primary practice address
500 W Main St Suite 16 Wyckoff NJ 07481-1439
Fax: (201) 847-0059
Website:

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anesthesiology 207L00000X MA56733 New Jersey

Profile Details

NPI number 1356319735
LBN Legal business name Ietta, Michael Angelo
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 10th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356319735 NPPES
New Jersey MEDICAID 5508207

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