Healthcare Provider Details

I. General information

NPI: 1750901633
Provider Name (Legal Business Name): VINCENT SINATRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2020
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

946 BLOOMFIELD AVE
GLEN RIDGE NJ
07028-1308
US

IV. Provider business mailing address

946 BLOOMFIELD AVE
GLEN RIDGE NJ
07028-1308
US

V. Phone/Fax

Practice location:
  • Phone: 973-743-1121
  • Fax:
Mailing address:
  • Phone: 973-743-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA12986100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: