Provider Demographics
NPI:1184052300
Name:DECATALDO, VINCENT (BOCPO,NJ LICENCE PO)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:DECATALDO
Suffix:
Gender:M
Credentials:BOCPO,NJ LICENCE PO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 W SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-6134
Mailing Address - Country:US
Mailing Address - Phone:908-925-0616
Mailing Address - Fax:
Practice Address - Street 1:1025 W SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-6134
Practice Address - Country:US
Practice Address - Phone:908-925-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00000600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist