Provider Demographics
NPI:1861414294
Name:VETRANO, JOSEPH SAM (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:SAM
Last Name:VETRANO
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 1:43 W FRONT ST
Mailing Address - Street 2:SUITE 14B
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1624
Mailing Address - Country:US
Mailing Address - Phone:732-747-0963
Mailing Address - Fax:732-747-0963
Practice Address - Street 1:43 W FRONT ST
Practice Address - Street 2:SUITE 14B
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1624
Practice Address - Country:US
Practice Address - Phone:732-747-0963
Practice Address - Fax:732-747-0963
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA028133002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0976806Medicaid
VE449489Medicare ID - Type Unspecified
NJ0976806Medicaid