Provider Demographics
NPI:1699088161
Name:AYAKO, VINCENT (NP-C)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:AYAKO
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 FRANKLIN AVE APT 205
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1783
Mailing Address - Country:US
Mailing Address - Phone:973-751-8411
Mailing Address - Fax:973-751-8757
Practice Address - Street 1:303 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1103
Practice Address - Country:US
Practice Address - Phone:973-751-8411
Practice Address - Fax:973-751-8757
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00298000363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health