Provider Demographics
NPI:1063493856
Name:VAGNINI, VINCENT
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:VAGNINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 PINE CRST
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9248
Mailing Address - Country:US
Mailing Address - Phone:518-899-5319
Mailing Address - Fax:
Practice Address - Street 1:NEW YORK ONCOLOGY HEMATOLOGY
Practice Address - Street 2:317 SOUTH MANNING BLVD. SUIT 310
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-489-0044
Practice Address - Fax:518-489-3591
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist