Provider Demographics
NPI:1457499279
Name:VASILE, VINCENT R (RPT)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:R
Last Name:VASILE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3117
Mailing Address - Country:US
Mailing Address - Phone:212-563-3730
Mailing Address - Fax:212-760-6383
Practice Address - Street 1:110 W 34TH ST
Practice Address - Street 2:SUITE 406
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2115
Practice Address - Country:US
Practice Address - Phone:212-563-3730
Practice Address - Fax:212-760-6383
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ76771OtherPHYSICAL THERAPY
NY00471361Medicaid
NY9177007OtherPHYSICAL THERAPY
NY6601215OtherPHYSICAL THERAPY
NYP746661OtherPHYSICAL THERAPY
NYQ76771OtherPHYSICAL THERAPY