Provider Demographics
NPI:1487691929
Name:VIGARIO, JOSE CARLOS (DO)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:CARLOS
Last Name:VIGARIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CENTRE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1564
Mailing Address - Country:US
Mailing Address - Phone:609-395-2470
Mailing Address - Fax:609-860-5288
Practice Address - Street 1:2 CENTRE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-1564
Practice Address - Country:US
Practice Address - Phone:609-395-2470
Practice Address - Fax:609-860-5288
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB60052207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ110178916OtherRAILROAD MEDICARE
NJ7758103Medicaid
NJ011593B3LMedicare ID - Type Unspecified
NJ7758103Medicaid