Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 25MA05121900 | NJ |
NPI | 1053353474 |
---|---|
Provider Name | Dr. Vincent Cubelli |
First Address | Denville, NJ 07834-2901 |
Second Address | Denville, NJ 07834-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 15/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C56916 | (02) | NJ |