Provider Demographics
NPI:1487632170
Name:DISABELLA, VINCENT (DO)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:DISABELLA
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 1:352 S DELSEA DR STE C
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-5306
Mailing Address - Country:US
Mailing Address - Phone:856-690-1616
Mailing Address - Fax:856-896-6107
Practice Address - Street 1:352 S DELSEA DR STE C
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-5306
Practice Address - Country:US
Practice Address - Phone:856-690-1616
Practice Address - Fax:856-896-6107
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC2-0005338207RS0010X
NJ25MB06246100207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE5091134OtherCIGNA
DE981003Medicaid
DE1316962OtherAETNA HMO
DE204753265OtherTRICARE
DE3156674OtherUNITED HEALTH CARE
DE2803741000OtherAMERIHEALTH
DE204753265OtherBLUE CROSS BLUE SHEILD DE
DE2803109000OtherINDEPENDENCE BLUE CROSS
DE442146OtherCOVENTRY
DE5933380OtherAETNA PPO
DE20-4753265OtherNATIONAL PROVIDER NETWORK
DE5933380OtherAETNA PPO
G31510Medicare UPIN