MEDICARE: MR. VINCENT DECATALDO BOCPO,NJ LICENCE PO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	45PO00000600	NJ

General Provider Information

NPI Number	:	1184052300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINCENT DECATALDO BOCPO,NJ LICENCE PO

Provider Business Mailing Address
First Line	:	1025 W SAINT GEORGES AVE
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-6134
Country	:	US
Telephone Number	:	908-925-0616
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 W SAINT GEORGES AVE
Second Line	:
City	:	LINDEN
State	:	NJ
Zip	:	07036-6134
Country	:	US
Telephone Number	:	908-925-0616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2013
Last Update Date	:	10/25/2013

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