Individual
MR. VINCENT F DESTASIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1851 HOOPER AVE, STA, TOMS RIVER, NJ 08753-8150
(732) 255-6566
(732) 255-3085
Mailing address
1851 HOOPER AVE, STA, TOMS RIVER, NJ 08753-8150
(732) 255-6566
(732) 255-3085
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MB51894
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5453208
—
NJ
01
—
D04846300
CDS
NJ
Enumeration date
06/20/2005
Last updated
03/07/2023
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