=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477902054
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDRE COLE D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2016
-----------------------------------------------------
Last Update Date | 07/10/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1206 W SHERMAN AVE BLDG 2A
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-6911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-696-9933
-----------------------------------------------------
Fax | 856-696-9939
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1206 W SHERMAN AVE BLDG 2A
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-6911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-696-9933
-----------------------------------------------------
Fax | 856-696-9939
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0129X
-----------------------------------------------------
Taxonomy Name | Vascular Surgery Physician
-----------------------------------------------------
License Number | 25MB11164600
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------