Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 71443 | GA |
NPI | 1073805149 |
---|---|
Provider Name | Dr. Vincent W. Tio |
First Address | Cresskill, NJ 07626-2423 |
Second Address | Rome, GA 30165-1415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2011 |
Last Update Date | 21/10/2016 |