Provider Demographics
NPI:1861579831
Name:LAFORGIA, SAL T (MD)
Entity type:Individual
Prefix:DR
First Name:SAL
Middle Name:T
Last Name:LAFORGIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:ISLAND HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:08732-0966
Mailing Address - Country:US
Mailing Address - Phone:732-773-3211
Mailing Address - Fax:
Practice Address - Street 1:780 ROUTE 37 W STE 235
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5065
Practice Address - Country:US
Practice Address - Phone:732-557-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67229207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ031348N4RMedicare ID - Type UnspecifiedRENDERING PHYSICIAN ID
NJ038112Medicare ID - Type UnspecifiedGROUP PROVIDER ID
G91002Medicare UPIN