Provider Demographics
NPI:1255483459
Name:CATANZARO, VINCENT (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:CATANZARO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:VINCENT
Other - Middle Name:
Other - Last Name:CAYANZARO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:128 BUEL AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-979-9770
Mailing Address - Fax:718-987-6994
Practice Address - Street 1:128 BUEL AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305
Practice Address - Country:US
Practice Address - Phone:718-979-9770
Practice Address - Fax:718-987-6994
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00339800111N00000X
NYX004690-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X274691Medicare ID - Type Unspecified