=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760439772
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF VINELAND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2006
-----------------------------------------------------
Last Update Date | 02/13/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 640 E WOOD ST
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08360-3722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-794-4000
-----------------------------------------------------
Fax | 856-794-1159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 640 E WOOD ST PO BOX 1508
-----------------------------------------------------
City | VINELAND
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08362-1508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-794-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MAYOR
-----------------------------------------------------
Name | MR. ANTHONY ROMEO FANUCCI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 856-794-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | VINE00614
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------