Provider Demographics
NPI:1073067971
Name:FRANK R. VEZZA M.D. PC
Entity Type:Organization
Organization Name:FRANK R. VEZZA M.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:R
Authorized Official - Last Name:VEZZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-869-9460
Mailing Address - Street 1:30 PEMBROKE DR
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-1788
Mailing Address - Country:US
Mailing Address - Phone:516-484-9746
Mailing Address - Fax:516-801-4175
Practice Address - Street 1:800 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3822
Practice Address - Country:US
Practice Address - Phone:516-869-9460
Practice Address - Fax:516-869-9462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193180207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01507175Medicaid
NY607882Medicare PIN