Provider Demographics
NPI:1447239397
Name:VINICK, DANIEL E (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:VINICK
Suffix:
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 1:134 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-4917
Mailing Address - Country:US
Mailing Address - Phone:845-357-5333
Mailing Address - Fax:845-357-2347
Practice Address - Street 1:134 ROUTE 59
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4917
Practice Address - Country:US
Practice Address - Phone:845-357-5333
Practice Address - Fax:845-357-2347
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224082207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02469363Medicaid
NY02469363Medicaid
NYG55475Medicare UPIN