Provider Demographics
NPI:1447200407
Name:JARRETT, VINCENT A (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:JARRETT
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 1:61 SKYLINE CIR
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-4345
Mailing Address - Country:US
Mailing Address - Phone:856-696-5800
Mailing Address - Fax:856-696-3503
Practice Address - Street 1:1103 S DELSEA DR
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6263
Practice Address - Country:US
Practice Address - Phone:856-696-5800
Practice Address - Fax:856-696-3503
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06260400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8120706Medicaid
NJ8120706Medicaid
NJH06024Medicare UPIN