Gerard Vaccarella Jr., PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

355100234200 Issued in NJ

Practice address

248 Boulevard
Hasbrouck Heights, NJ 07604-1935

Phone

(201) 288-4611

Fax

(201) 288-8107

NPI assigned

Aug 14, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/mhcp/r4/

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073526588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "248 BOULEVARD",
            "city": "HASBROUCK HEIGHTS",
            "state": "NJ",
            "postal_code": "076041935",
            "telephone_number": "201-288-4611",
            "fax_number": "201-288-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "248 BOULEVARD",
            "city": "HASBROUCK HEIGHTS",
            "state": "NJ",
            "postal_code": "076041935",
            "telephone_number": "201-288-4611",
            "fax_number": "201-288-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VACCARELLA",
        "first_name": "GERARD",
        "name_suffix": "Jr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NJ",
            "license": "355100234200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN #",
            "identifier": "7920122",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609106",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUE CROSS",
            "identifier": "V4951",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Hasbrouck Heights, NJ
• Providers in Hasbrouck Heights, NJ by specialty
• Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.