Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 22DI01486600 | NJ |
NPI | 1114088358 |
---|---|
Provider Name | Dr. Fred J. Vecchione |
First Address | Hamilton, NJ 08619 |
Second Address | Hamilton, NJ 08619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2006 |
Last Update Date | 04/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
025317 | (02) | NJ |