Individual
CASSANDRA VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
350 BOULEVARD, PASSAIC, NJ 07055-2840
(973) 365-4566
(973) 365-4651
Mailing address
277 MILLBROOK AVE, RANDOLPH, NJ 07869-2105
(973) 365-4566
(973) 365-4651
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00119500
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MP00119500
NJ MEDICAL LICENS
NJ
Enumeration date
07/19/2007
Last updated
05/07/2008
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