Healthcare Provider Details

I. General information

NPI: 1356401004
Provider Name (Legal Business Name): FRED J. VECCHIONE , D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NAMI LANE SUITE 2
HAMILTON NJ
08619
US

IV. Provider business mailing address

1 NAMI LANE SUITE 2
HAMILTON NJ
08619
US

V. Phone/Fax

Practice location:
  • Phone: 609-520-0046
  • Fax: 609-838-0117
Mailing address:
  • Phone: 609-520-0046
  • Fax: 609-838-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number22DI01486600
License Number StateNJ

VIII. Authorized Official

Name: DR. FRED J. VECCHIONE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: D.D.S.
Phone: 609-520-0046