Provider Demographics
NPI:1265461347
Name:LACSINA, VINCENT MANALANG (PT)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:MANALANG
Last Name:LACSINA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 LEBER AVE
Mailing Address - Street 2:
Mailing Address - City:CARTERET
Mailing Address - State:NJ
Mailing Address - Zip Code:07008-1941
Mailing Address - Country:US
Mailing Address - Phone:732-231-6922
Mailing Address - Fax:732-231-6922
Practice Address - Street 1:72 LEBER AVE
Practice Address - Street 2:
Practice Address - City:CARTERET
Practice Address - State:NJ
Practice Address - Zip Code:07008-1941
Practice Address - Country:US
Practice Address - Phone:732-231-6922
Practice Address - Fax:732-231-6922
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQQ8551Medicare ID - Type Unspecified