Provider Demographics
NPI:1275562605
Name:MARONE, VINCENT A
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:A
Last Name:MARONE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 PEBBLE LN
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-5577
Mailing Address - Country:US
Mailing Address - Phone:856-374-0510
Mailing Address - Fax:
Practice Address - Street 1:10 HIGH ST E
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-2520
Practice Address - Country:US
Practice Address - Phone:856-881-5121
Practice Address - Fax:856-881-9552
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12537183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4274806Medicaid
NJ1932135480OtherMEDICARE