Provider Demographics
NPI:1184628018
Name:ACELLO, ANTHONY NICOLAS (DPM)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:NICOLAS
Last Name:ACELLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 AMBOY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08837
Mailing Address - Country:US
Mailing Address - Phone:732-225-1500
Mailing Address - Fax:732-225-1377
Practice Address - Street 1:1043 AMBOY AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08837
Practice Address - Country:US
Practice Address - Phone:732-225-1500
Practice Address - Fax:732-225-1377
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD02197213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU50005Medicare UPIN
NJ1220940001Medicare NSC
NJ1184628018Medicare PIN