Provider Demographics
NPI:1437265196
Name:JUSTINO, VINCENT A (DC)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:JUSTINO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1311
Mailing Address - Country:US
Mailing Address - Phone:845-255-5733
Mailing Address - Fax:845-255-5766
Practice Address - Street 1:218 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561
Practice Address - Country:US
Practice Address - Phone:845-255-5733
Practice Address - Fax:845-255-5766
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U72386Medicare UPIN
NYX2B711Medicare PIN