Provider Demographics
NPI:1104823293
Name:PAGANO, VITO (DC)
Entity Type:Individual
Prefix:MR
First Name:VITO
Middle Name:
Last Name:PAGANO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 TREE FREE RD STE B220
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534
Mailing Address - Country:US
Mailing Address - Phone:609-730-1970
Mailing Address - Fax:609-730-1972
Practice Address - Street 1:2 TREE FARM RD STE B220
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-1488
Practice Address - Country:US
Practice Address - Phone:609-730-1970
Practice Address - Fax:609-730-1972
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00496700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8140006Medicaid
U67831Medicare UPIN
NJ892785Medicare ID - Type Unspecified