Provider Demographics
NPI:1144586132
Name:MICCIO, VINCENT FERDINAND JR (MD)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:FERDINAND
Last Name:MICCIO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:162 16TH ST APT 8A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-8711
Mailing Address - Country:US
Mailing Address - Phone:781-439-1979
Mailing Address - Fax:
Practice Address - Street 1:38 6TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-4350
Practice Address - Country:US
Practice Address - Phone:718-362-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2851242081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine