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General NPI Number Information
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NPI Number | 1487632170
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Entity Type | Individual
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Provider Name | VINCENT DISABELLA DO
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Gender | Male
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Dates
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Enumeration Date | 01/04/2006
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Last Update Date | 10/11/2021
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Provider Practice Location Address
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Address Line | 352 S DELSEA DR STE C
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City | VINELAND
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State | NJ
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Zip | 08360-5306
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Country | US
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Telephone | 856-690-1616
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Fax | 856-896-6107
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Provider Business Mailing Address
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Address Line | 352 S DELSEA DR STE C
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City | VINELAND
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State | NJ
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Zip | 08360-5306
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Country | US
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Telephone | 856-690-1616
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Fax | 856-896-6107
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | C2-0005338
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 25MB06246100
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License Number State | NJ
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