Healthcare Provider Details

I. General information

NPI: 1841242393
Provider Name (Legal Business Name): VINCENT S PANELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 GRAND AVE SUITE 101
ENGLEWOOD NJ
07631-4152
US

IV. Provider business mailing address

420 GRAND AVE SUITE 101
ENGLEWOOD NJ
07631-4152
US

V. Phone/Fax

Practice location:
  • Phone: 201-569-7044
  • Fax: 201-569-1999
Mailing address:
  • Phone: 201-569-7044
  • Fax: 201-569-1999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA04951400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: