Provider Demographics
NPI:1154300689
Name:DEVINCENZO, SALVATORE J (MD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:J
Last Name:DEVINCENZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20 GRAND STREET
Mailing Address - Street 2:3RD FL
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-987-3906
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:70 HATFIELD LN
Practice Address - Street 2:SUITE 101
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6734
Practice Address - Country:US
Practice Address - Phone:845-294-8888
Practice Address - Fax:845-294-1669
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2017-08-21
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Provider Licenses
StateLicense IDTaxonomies
NY145343207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00787357Medicaid
NY110035384OtherRAILROAD MEDICARE PIN
NY04D561Medicare PIN
A97570Medicare UPIN