Active NPI
Virgilio Coronado Vicente, MD
- Pediatrics Physician
- Newark, NJ
National Provider Identifier
1780790998
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 25MA06381500
- Practice address
- 155 Jefferson St
Suite # 3
Newark, NJ 07105-1706 - Phone
- (973) 466-0300
- Fax
- (973) 466-1117
- NPI assigned
- Aug 21, 2006
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 25MA06381500 | NJ | Primary |
Addresses
Primary practice location
155 Jefferson St
Suite # 3
Newark, NJ 07105-1706
Mailing address
PO Box 254
West Orange, NJ 07052-0254
Phone (973) 466-0300
Other identifiers 20
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 607241 | Other | EMPIRE | |
| 7949804 | Other | UNISYS MEDICAID | |
| 8763000002 | Other | CIGNA | |
| K0845 | Other | HORIZON BCBS | |
| 01000200803 | Other | AMERICHOICE | |
| 01000200800 | Other | AMERICHOICE | |
| 8763000 | Other | CIGNA | |
| 2072459000 | Other | AMERIHEALTH PPO HMO | |
| 2017754 | Other | UNITED HEALTH CARE | |
| 7949804 | Medicaid | NJ | |
| 2327481 | Other | AETNA | |
| 25087 | Other | UNIVERSITY HEALTH PLANS | |
| 2695833 | Other | GHI | |
| P3512598 | Other | OXFORD | |
| 607241 | Other | WELLCHOICE | |
| 91899 | Other | AMERICAID | |
| 1135312 | Other | HORIZON NJ HEALTH | |
| 2366072 | Other | AETNA | |
| 2K5847 | Other | ACS HEALTHNET | |
| 91899 | Other | AMERIGROUP |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA06381500 | NJ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472083200000",
"number": "1780790998",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 254",
"city": "WEST ORANGE",
"state": "NJ",
"postal_code": "070520254",
"telephone_number": "973-466-0300",
"fax_number": "973-466-1117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "155 JEFFERSON ST",
"address_2": "SUITE # 3",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071051706",
"telephone_number": "973-466-0300",
"fax_number": "973-466-1117"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICENTE",
"first_name": "VIRGILIO",
"middle_name": "CORONADO",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-21",
"last_updated": "2016-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "25MA06381500",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE",
"identifier": "607241",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISYS MEDICAID",
"identifier": "7949804",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "8763000002",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HORIZON BCBS",
"identifier": "K0845",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "01000200803",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "01000200800",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "8763000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH PPO HMO",
"identifier": "2072459000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "2017754",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7949804",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2327481",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNIVERSITY HEALTH PLANS",
"identifier": "25087",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHI",
"identifier": "2695833",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P3512598",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLCHOICE",
"identifier": "607241",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICAID",
"identifier": "91899",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HORIZON NJ HEALTH",
"identifier": "1135312",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "2366072",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ACS HEALTHNET",
"identifier": "2K5847",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "91899",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.