Provider Demographics
NPI:1487634457
Name:EMILIANI, VINCENT J (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:EMILIANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 POCONO RD
Mailing Address - Street 2:STE 201
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2901
Mailing Address - Country:US
Mailing Address - Phone:973-627-4430
Mailing Address - Fax:973-586-2336
Practice Address - Street 1:16 POCONO RD
Practice Address - Street 2:STE 201
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2901
Practice Address - Country:US
Practice Address - Phone:973-627-4430
Practice Address - Fax:973-586-2336
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ544885A9S174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1222406Medicaid
NJ1222406Medicaid
NJ544885A9SMedicare ID - Type Unspecified
NJ110027690Medicare PIN