Provider Demographics
NPI:1174281869
Name:VASSALLO, PAGE
Entity Type:Individual
Prefix:
First Name:PAGE
Middle Name:
Last Name:VASSALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6800 COLUMBIA AVE APT 10G
Mailing Address - Street 2:
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-3618
Mailing Address - Country:US
Mailing Address - Phone:201-948-7412
Mailing Address - Fax:
Practice Address - Street 1:6800 COLUMBIA AVE APT 10G
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-3618
Practice Address - Country:US
Practice Address - Phone:201-948-7412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider