Provider Demographics
NPI:1659556454
Name:VINCENT F GIACALONE
Entity Type:Organization
Organization Name:VINCENT F GIACALONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:GIACALONE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:201-261-0500
Mailing Address - Street 1:466 OLD HOOK RD
Mailing Address - Street 2:SUITE 24D
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1396
Mailing Address - Country:US
Mailing Address - Phone:201-261-0500
Mailing Address - Fax:201-261-7905
Practice Address - Street 1:466 OLD HOOK RD
Practice Address - Street 2:SUITE 24D
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1396
Practice Address - Country:US
Practice Address - Phone:201-261-0500
Practice Address - Fax:201-261-7905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD001923332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
T96156Medicare UPIN
4679980001Medicare NSC