Provider Demographics
NPI:1508034620
Name:PROIETTI, VINCENT JOSEPH (BS, BPH, JD)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:PROIETTI
Suffix:
Gender:M
Credentials:BS, BPH, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1909
Mailing Address - Country:US
Mailing Address - Phone:201-288-5356
Mailing Address - Fax:201-288-5356
Practice Address - Street 1:400 DEMAREST AVE
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-2513
Practice Address - Country:US
Practice Address - Phone:201-784-7190
Practice Address - Fax:201-784-7197
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037701-1183500000X
CTPCT.0007894183500000X
NJ28RI01279400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY037701-1OtherRPH
NJ28RI01279400OtherRPH
CTPCT.0007894OtherRPH