Provider Demographics
NPI:1538484191
Name:INCOGNOLI, VINCENT (MA, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:INCOGNOLI
Suffix:
Gender:M
Credentials:MA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 WILCOX AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1622
Mailing Address - Country:US
Mailing Address - Phone:646-210-3508
Mailing Address - Fax:
Practice Address - Street 1:824 WILCOX AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1622
Practice Address - Country:US
Practice Address - Phone:646-210-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist