Provider Demographics
NPI:1518147834
Name:INDELICATO, VINCENT (OD)
Entity Type:Individual
Prefix:MISS
First Name:VINCENT
Middle Name:
Last Name:INDELICATO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6819 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-4416
Mailing Address - Country:US
Mailing Address - Phone:718-236-6090
Mailing Address - Fax:718-236-6090
Practice Address - Street 1:6819 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-4416
Practice Address - Country:US
Practice Address - Phone:718-236-6090
Practice Address - Fax:718-236-6090
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003893-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01105031Medicaid
NY01105031Medicaid