Provider Demographics
NPI:1114076940
Name:VERGINIO, VINCENT J (PT, CEERT MDT)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:J
Last Name:VERGINIO
Suffix:
Gender:M
Credentials:PT, CEERT MDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 W UTICA ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3048
Mailing Address - Country:US
Mailing Address - Phone:315-342-2738
Mailing Address - Fax:315-342-2815
Practice Address - Street 1:90 W UTICA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3048
Practice Address - Country:US
Practice Address - Phone:315-342-2738
Practice Address - Fax:315-342-2815
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0102651225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10011140070OtherFAMILYCHILD UHC
NY4130732OtherMVP SELECT CARE
NYBB5787Medicare ID - Type UnspecifiedMCARE BILLING NUMBER