Provider Demographics
NPI:1225297773
Name:DEVINCENTIS,DPM-DEVINCENTIS,DPM
Entity Type:Organization
Organization Name:DEVINCENTIS,DPM-DEVINCENTIS,DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:DEVINCENTIS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-662-1003
Mailing Address - Street 1:4200 N BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2415
Mailing Address - Country:US
Mailing Address - Phone:716-662-1003
Mailing Address - Fax:716-667-1315
Practice Address - Street 1:4200 N BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-2415
Practice Address - Country:US
Practice Address - Phone:716-662-1003
Practice Address - Fax:716-667-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002275-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0924440002OtherDME MAC JURISDICTION A
NY0924440002OtherDME MAC JURISDICTION A