MEDICARE: MR. VINCENT TRINIDAD NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ01000900	NJ

General Provider Information

NPI Number	:	1538791504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINCENT TRINIDAD NP-C

Provider Business Mailing Address
First Line	:	2 MARC CT
Second Line	:
City	:	PARLIN
State	:	NJ
Zip	:	08859-3100
Country	:	US
Telephone Number	:	732-313-6904
Fax Number	:

Provider Business Practice Location Address
First Line	:	ONE ROBERT WOOD JOHNSON PLACE
Second Line	:	MEDICAL EDUCATION BUILDING -2ND FLOOR
City	:	NEW BRUNSWICK
State	:	NJ
Zip	:	08901-0890
Country	:	US
Telephone Number	:	908-685-3732
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	03/05/2020

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