Provider Demographics
NPI:1528362308
Name:IODICE, VINCENT JOHN (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:JOHN
Last Name:IODICE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5431
Mailing Address - Country:US
Mailing Address - Phone:718-336-6111
Mailing Address - Fax:718-336-6111
Practice Address - Street 1:2378 E 5TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5431
Practice Address - Country:US
Practice Address - Phone:718-336-6111
Practice Address - Fax:718-336-6111
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist