NPIMap

Organization Active NPI

Codella Family Practice

  • Family Medicine Physician
  • Union, NJ
National Provider Identifier
1871632075
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MB074566 Issued in NJ
Legal business name
CODELLA FAMILY PRACTICE
Practice address
1050 Galloping Hill Road
Suite 102
Union, NJ 07083
Phone
(908) 688-1550
Fax
(908) 688-1552
NPI assigned
Feb 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Vincent Codella, DONPI 1134111248
Title
Physician
Phone
(908) 688-1550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X MB074566 NJ Primary

Addresses

Primary practice location

1050 Galloping Hill Road
Suite 102
Union, NJ 07083

Mailing address

1050 Galloping Hill Road
Suite 102
Union, NJ 07083
Phone (908) 688-1550

Other identifiers 2

IdentifierTypeStateIssuer
0047171MedicaidNJ
0047198MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041217000283 NJ Part B Supplier - Clinic/Group Practice 7012974322 Receives reassigned benefits from 3 practitioners
Practice locations: Union, NJ

National Provider Directory

National Provider Directory

Locations

1000 Galloping Hill Rd
Ste 103
Union, NJ 07083
Phone (908) 688-1550

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871632075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 GALLOPING HILL ROAD",
            "address_2": "SUITE 102",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "07083",
            "telephone_number": "908-688-1550",
            "fax_number": "908-688-1552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 GALLOPING HILL ROAD",
            "address_2": "SUITE 102",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "07083",
            "telephone_number": "908-688-1550",
            "fax_number": "908-688-1552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CODELLA FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CODELLA",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "908-688-1550",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "MB074566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0047171",
            "state": "NJ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0047198",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Union, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.