Healthcare Provider Details

I. General information

NPI: 1508538190
Provider Name (Legal Business Name): ANDREW J VACCARELLA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1940 S WEST BLVD BLDG A
VINELAND NJ
08360-7024
US

IV. Provider business mailing address

1311 MAMARONECK AVE STE 140
WHITE PLAINS NY
10605-5224
US

V. Phone/Fax

Practice location:
  • Phone: 856-690-9977
  • Fax: 856-507-9918
Mailing address:
  • Phone: 888-830-4125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02048900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: