Provider Demographics
NPI:1649234113
Name:LEPORE, VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:LEPORE
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:PO BOX 7554
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-7554
Mailing Address - Country:US
Mailing Address - Phone:732-957-9696
Mailing Address - Fax:732-957-9611
Practice Address - Street 1:2 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-3438
Practice Address - Country:US
Practice Address - Phone:732-957-9696
Practice Address - Fax:732-957-9611
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00267200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJLE597070Medicare ID - Type Unspecified
NJT77845Medicare UPIN