Provider Demographics
NPI:1841242393
Name:PANELLA, VINCENT S (MD)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:S
Last Name:PANELLA
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 1:420 GRAND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4152
Mailing Address - Country:US
Mailing Address - Phone:201-569-7044
Mailing Address - Fax:201-569-1999
Practice Address - Street 1:420 GRAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4152
Practice Address - Country:US
Practice Address - Phone:201-569-7044
Practice Address - Fax:201-569-1999
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04951400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0990400Medicaid
NJ13A881OtherEMPIRE HEALTH PLAN
NJ2400475OtherGHI
NJ46052OtherAETNA US HELTHCARE
NJBS239OtherOXFORD
NJOK2490OtherHEALTHNET
NJOK2490OtherHEALTHNET
NJ101147BPCMedicare PIN