Provider Demographics
NPI:1134111248
Name:CODELLA, VINCENT (DO)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CODELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 GALLOPING HILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7983
Mailing Address - Country:US
Mailing Address - Phone:908-688-1550
Mailing Address - Fax:908-688-1552
Practice Address - Street 1:1050 GALLOPING HILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7983
Practice Address - Country:US
Practice Address - Phone:908-688-1550
Practice Address - Fax:908-688-1552
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB074566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
7986512OtherAETNA TRADITIONAL
2374962000OtherAMERIHEALTH
2478929OtherUNITED HEALTHCARE
2K5477OtherHEALTHNET
3655426OtherAETNA HMO
NJ201213421OtherBLUE CROSS/BLUE SHIELD
60014177OtherHORIZON NJ HEALTH
201213421002OtherSAINT BARNABAS HEALTH SYS
01000728000OtherAMERICHOICE
8221554OtherGHI
1010599OtherCIGNA
NJK5482OtherBLUE CROSS/BLUE SHIELD
NJ0047198Medicaid
2374962000OtherAMERIHEALTH
3655426OtherAETNA HMO