Provider Demographics
NPI:1508956921
Name:RULLO, VINCENT VICTOR JR (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:VICTOR
Last Name:RULLO
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BETHANY ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730
Mailing Address - Country:US
Mailing Address - Phone:732-888-0077
Mailing Address - Fax:732-888-0815
Practice Address - Street 1:82 BETHANY ROAD
Practice Address - Street 2:SUITE 7
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07936
Practice Address - Country:US
Practice Address - Phone:732-888-0077
Practice Address - Fax:732-888-0815
Is Sole Proprietor?:No
Enumeration Date:2006-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC04003111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U24104Medicare UPIN
NJ689770Medicare ID - Type Unspecified