Provider Demographics
NPI:1558300327
Name:ELETTO, VINCENT J (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:J
Last Name:ELETTO
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 1:66 WEST GILBERT STREET
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4918
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:503 ROUTE 202
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869-1574
Practice Address - Country:US
Practice Address - Phone:908-557-9802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06813700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6004428OtherHORIZON NJ HEALTH
NJ223586664OtherTRICARE/CHAMPUS
NJ223586664OtherBCBS
NJ5002702Medicaid
NJ076636XZMMedicare PIN
NJ076636Medicare ID - Type Unspecified
NYP00424127Medicare PIN
NJ223586664OtherTRICARE/CHAMPUS