Provider Demographics
NPI:1073540126
Name:VACCARELLA, PAUL J (OD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:J
Last Name:VACCARELLA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 SHADOW HILL WAY
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-5672
Mailing Address - Country:US
Mailing Address - Phone:908-979-1183
Mailing Address - Fax:
Practice Address - Street 1:301 MOUNT HOPE AVE
Practice Address - Street 2:SUITE 2002
Practice Address - City:ROCKAWAY
Practice Address - State:NJ
Practice Address - Zip Code:07866-2130
Practice Address - Country:US
Practice Address - Phone:973-366-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2009-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00512900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ695156Medicare ID - Type Unspecified
NJU23587Medicare UPIN