Provider Demographics
NPI:1588654487
Name:VACCARELLA, STEVEN FRANK (DC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:FRANK
Last Name:VACCARELLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-2051
Mailing Address - Country:US
Mailing Address - Phone:201-944-6500
Mailing Address - Fax:201-944-6555
Practice Address - Street 1:240 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:LEONIA
Practice Address - State:NJ
Practice Address - Zip Code:07605-2051
Practice Address - Country:US
Practice Address - Phone:201-944-6500
Practice Address - Fax:201-944-6555
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03382111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5171105Medicaid
T73051Medicare UPIN
NJ5171105Medicaid