Provider Demographics
NPI:1154361079
Name:CALLIGARO, BRUCE DAVID (DPM)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DAVID
Last Name:CALLIGARO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 HAMBURG TURNPIKE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2160
Mailing Address - Country:US
Mailing Address - Phone:973-595-8900
Mailing Address - Fax:973-595-0330
Practice Address - Street 1:426 HAMBURG TURNPIKE
Practice Address - Street 2:SUITE 204
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2160
Practice Address - Country:US
Practice Address - Phone:973-595-8900
Practice Address - Fax:973-595-0330
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2009-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ1081213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT83036Medicare UPIN
NJWA401833Medicare ID - Type Unspecified