Active NPI
Vincent Derisio, DO
- Anatomic Pathology & Clinical Pathology Physician
- Stratford, NJ
National Provider Identifier
1427538701
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 25MB05189300
- Practice address
- 42 E Laurel Rd
Stratford, NJ 08084-1354 - Phone
- (513) 300-6910
- NPI assigned
- Aug 16, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 25MB05189300 | NJ | Primary |
Addresses
Primary practice location
42 E Laurel Rd
Stratford, NJ 08084-1354
Mailing address
PO Box 612
Stratford, NJ 08084-0612
Phone (513) 300-6910
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MB05189300 | NJ | MD | Anatomic Pathology & Clinical Pathology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534377600000",
"number": "1427538701",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 612",
"city": "STRATFORD",
"state": "NJ",
"postal_code": "080840612",
"telephone_number": "513-300-6910"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "42 E LAUREL RD",
"city": "STRATFORD",
"state": "NJ",
"postal_code": "080841354",
"telephone_number": "513-300-6910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DERISIO",
"first_name": "VINCENT",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-16",
"last_updated": "2018-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "NJ",
"license": "25MB05189300",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stratford, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.