Basic Information
| Provider Information | |||||||||
| NPI: | 1841227774 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GRACIAS | ||||||||
| FirstName: | VICENTE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 66 W GILBERT ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | TINTON FALLS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077014947 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322120051 | ||||||||
| FaxNumber: | 7322120713 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 PATERSON ST | ||||||||
| Address2: | SUITE 4100 | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089011962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322357920 | ||||||||
| FaxNumber: | 7322357079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 11/19/2012 | ||||||||
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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 | 2086S0102X | MD063973L | PA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 25MA08592500 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0127X | 25MA08592500 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0102X | 25MA08592500 | NJ | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
ID Information
| ID | Type | State | Issuer | Description | 0017085020001 | 05 | PA | MEDICAID | 7673302 | 05 | NJ | MEDICAID | P01069324 | 01 | NJ | RAILROAD MEDICARE | OTHER |