Provider Demographics
NPI:1003804394
Name:VINCETIC, ANTO (DPM)
Entity Type:Individual
Prefix:
First Name:ANTO
Middle Name:
Last Name:VINCETIC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3626 E TREMONT AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465
Mailing Address - Country:US
Mailing Address - Phone:718-409-0400
Mailing Address - Fax:718-518-1281
Practice Address - Street 1:3626 E TREMONT AVE STE 102
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2030
Practice Address - Country:US
Practice Address - Phone:718-409-0400
Practice Address - Fax:718-518-1281
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2017-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005796213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02217729Medicaid
NYPE2581Medicare ID - Type Unspecified
U83676Medicare UPIN