Provider Demographics
NPI:1073695136
Name:CIRELLA, VINCENT N (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:N
Last Name:CIRELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07754-0307
Mailing Address - Country:US
Mailing Address - Phone:732-897-0200
Mailing Address - Fax:732-897-0263
Practice Address - Street 1:1945 HIGHWAY 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-897-0200
Practice Address - Fax:732-897-0263
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA52920207L00000X
NJ25MA05292000207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0264806Medicaid
NJ404047CDZMedicare PIN
NJ404047DBHMedicare PIN
NJ0264806Medicaid
NJ404047C8XMedicare PIN
NJ404047A01Medicare PIN
NJ404047CDYMedicare PIN
NJ404047AOLMedicare PIN