Healthcare Provider Details

I. General information

NPI: 1073888434
Provider Name (Legal Business Name): JOSEPH BAYER VELLA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RUTGERS - ROBERT WOOD JOHNSON UNIVERSITY 10 PLUM STREET
NEW BRUNSWICK NJ
08901
US

IV. Provider business mailing address

1 JOHN PLANT DR
HIGHTSTOWN NJ
08520-3424
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5530
  • Fax:
Mailing address:
  • Phone: 412-720-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number291195-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MA10474800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number25MA10474800
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number25MA10474800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: