Healthcare Provider Details

I. General information

NPI: 1902840143
Provider Name (Legal Business Name): TERESA VACCARO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KIMBALL MEDICAL CENTER 600 RIVER AVENUE
LAKEWOOD NJ
08701
US

IV. Provider business mailing address

PO BOX 717
LIVINGSTON NJ
07039-0717
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-1900
  • Fax:
Mailing address:
  • Phone: 973-740-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00095600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: