Provider Demographics
NPI:1871560243
Name:VACCARO, CARMINE ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:CARMINE
Middle Name:ANTHONY
Last Name:VACCARO
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 1:19 CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-3231
Mailing Address - Country:US
Mailing Address - Phone:732-922-1656
Mailing Address - Fax:
Practice Address - Street 1:19 CAMBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-3231
Practice Address - Country:US
Practice Address - Phone:732-922-1656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA028018207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1129805Medicaid
NJ459861Medicare ID - Type Unspecified
NJ1129805Medicaid