Provider Demographics
NPI:1356401004
Name:FRED J. VECCHIONE , D.D.S., P.C.
Entity type:Organization
Organization Name:FRED J. VECCHIONE , D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:J
Authorized Official - Last Name:VECCHIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:609-520-0046
Mailing Address - Street 1:1 NAMI LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619
Mailing Address - Country:US
Mailing Address - Phone:609-520-0046
Mailing Address - Fax:609-838-0117
Practice Address - Street 1:1 NAMI LANE
Practice Address - Street 2:SUITE 2
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619
Practice Address - Country:US
Practice Address - Phone:609-520-0046
Practice Address - Fax:609-838-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI014866001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ025317Medicare PIN