Provider Demographics
NPI:1770575037
Name:ACOCELLA, MICHAEL ANTHONY (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:ACOCELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 WESTFIELD AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2454
Mailing Address - Country:US
Mailing Address - Phone:732-381-5565
Mailing Address - Fax:732-381-5222
Practice Address - Street 1:138 WESTFIELD AVE
Practice Address - Street 2:STE 5
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2454
Practice Address - Country:US
Practice Address - Phone:732-381-5565
Practice Address - Fax:732-381-5222
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB58946207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6131701Medicaid
NJ766760Medicare ID - Type Unspecified
F78663Medicare UPIN