Healthcare Provider Details

I. General information

NPI: 1790215853
Provider Name (Legal Business Name): VINCENT MARCHESE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2171 ROUTE 70 W
CHERRY HILL NJ
08002-2733
US

IV. Provider business mailing address

500 GROVE ST STE 600
HADDON HEIGHTS NJ
08035-1761
US

V. Phone/Fax

Practice location:
  • Phone: 856-406-0023
  • Fax:
Mailing address:
  • Phone: 609-941-4321
  • Fax: 856-219-9322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberOT017972
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB11037200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: