| Vincent J Fusella Phd Pc | |
|
One Woodbridge Center Suite 505 Woodbridge NJ 07095 | |
| (732) 636-6165 | |
| (732) 636-6172 |
| Full Name | Vincent J Fusella Phd Pc |
|---|---|
| Speciality | Psychologist |
| Location | One Woodbridge Center, Woodbridge, New Jersey |
| Authorized Official Name and Position | Vincent J Fusella (PRESIDENT) |
| Authorized Official Contact | 7326366165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vincent J Fusella Phd Pc One Woodbridge Center Suite 505 Woodbridge NJ 07095 Ph: (732) 636-6165 | Vincent J Fusella Phd Pc One Woodbridge Center Suite 505 Woodbridge NJ 07095 Ph: (732) 636-6165 |
| NPI Number | 1255615571 |
|---|---|
| Provider Enumeration Date | 10/05/2011 |
| Last Update Date | 10/05/2011 |
| Medicare PECOS PAC ID | 6103090949 |
|---|---|
| Medicare Enrollment ID | O20111114000372 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255615571 | NPI | - | NPPES |
| 1646206 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 35SI00118000 (New Jersey) | Primary |
| Provider Name | Vincent J Fusella |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1306987698 PECOS PAC ID: 1557534419 Enrollment ID: I20111109000646 |
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