Provider Demographics
NPI:1194912295
Name:CANABAL, VINCENT PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PAUL
Last Name:CANABAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 NEW ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-2006
Mailing Address - Country:US
Mailing Address - Phone:973-450-9821
Mailing Address - Fax:
Practice Address - Street 1:46 NEW ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-2006
Practice Address - Country:US
Practice Address - Phone:973-450-9821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ23MA08596700207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine