Provider Demographics
NPI:1275595696
Name:PICCONE, VINCENT ARTHUR II (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ARTHUR
Last Name:PICCONE
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N GANNON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4374
Mailing Address - Country:US
Mailing Address - Phone:718-494-7272
Mailing Address - Fax:
Practice Address - Street 1:245 N GANNON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4374
Practice Address - Country:US
Practice Address - Phone:718-494-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY82205-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001202326Medicaid