Healthcare Provider Details

I. General information

NPI: 1962595629
Provider Name (Legal Business Name): VANJELO P ABELLAR RPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 ROOSEVELT AVE.
CARTERET NJ
07008
US

IV. Provider business mailing address

34 E COLFAX AVE.
ROSELLE PARK NJ
07204
US

V. Phone/Fax

Practice location:
  • Phone: 732-541-2233
  • Fax: 732-541-2234
Mailing address:
  • Phone: 732-541-2233
  • Fax: 732-541-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number40QA01194700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: