Provider Demographics
NPI:1669515888
Name:ASANZA, VICENTE OLIVA (MD)
Entity type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:OLIVA
Last Name:ASANZA
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 1:651 ROUTE 37 W
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-8060
Mailing Address - Country:US
Mailing Address - Phone:732-341-4540
Mailing Address - Fax:732-349-5583
Practice Address - Street 1:651 ROUTE 37 W
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8060
Practice Address - Country:US
Practice Address - Phone:732-341-4540
Practice Address - Fax:732-349-5583
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA024649174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1865803Medicaid
NJ1865803Medicaid
C63101Medicare UPIN