Provider Demographics
NPI:1578554796
Name:GRAZIANO, VINCENT ANGELO (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANGELO
Last Name:GRAZIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:246 HAMBURG TPKE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2150
Mailing Address - Country:US
Mailing Address - Phone:973-653-3366
Mailing Address - Fax:973-653-3365
Practice Address - Street 1:246 HAMBURG TPKE
Practice Address - Street 2:SUITE 207
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2150
Practice Address - Country:US
Practice Address - Phone:973-653-3366
Practice Address - Fax:973-653-3365
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2008-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37894207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1042675OtherHORIZON NJ HEALTH
NJ1606301Medicaid
NJ1993694OtherUNITED HEALTHCARE
NJ5710244OtherGHI
NJ91001442300OtherAMERICHOICE
NJ0072037000OtherAMERIHEALTH
NJCC8414OtherRAILROAD MEDICARE
NJ0934255OtherCIGNA
NJ221963249OtherQUALCARE
NJ4300272OtherAETNA
NJ11007OtherAMERIGROUP
NJOK2308OtherHEALTHNET
NJBS671OtherOXFORD
NJC53937Medicare UPIN
NJBS671OtherOXFORD