Basic Information
| Provider Information | |||||||||
| NPI: | 1275586737 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILETO | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | F. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 UNION AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088073063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087222900 | ||||||||
| FaxNumber: | 9087221856 | ||||||||
| Practice Location | |||||||||
| Address1: | 215 UNION AVE | ||||||||
| Address2: | |||||||||
| City: | BRIDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088073063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9087222900 | ||||||||
| FaxNumber: | 9087221856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 06/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MA3586900 | NJ | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | AM8671124 | 01 | FED DRUG ENFORCE ADM | OTHER | D027143 | 01 | NJ | STATE CONTROLLED DRUG SUB | OTHER | 25MA03586900 | 01 | NJ | NJ STATE LICENSE | OTHER | 0845001 | 05 | NJ | MEDICAID |