Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 285124 | NY |
NPI | 1144586132 |
---|---|
Provider Name | Mr. Vincent Ferdinand Miccio JR. |
First Address | Brooklyn, NY 11215-7346 |
Second Address | New York, NY 10022-1475 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2012 |
Last Update Date | 17/03/2018 |