Individual
VINCENT DERISIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
42 E LAUREL RD, STRATFORD, NJ 08084-1354
(513) 300-6910
Mailing address
PO BOX 612, STRATFORD, NJ 08084-0612
(513) 300-6910
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
25MB05189300
NJ
Other
Enumeration date
08/16/2018
Last updated
08/16/2018
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