Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 005796 | NY |
Y | 222Z00000X | Podiatrist | 005796 | NY |
NPI | 1003804394 |
---|---|
Provider Name | Anto Vincetic |
First Address | Bronx, NY 10465 |
Second Address | Bronx, NY 10465-2030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 25/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02217729 | (05) | NY |
U83676 | (02) |