Provider Demographics
NPI:1578765608
Name:DURON, VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:DURON
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:PO BOX 27036
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7036
Mailing Address - Country:US
Mailing Address - Phone:212-305-9576
Mailing Address - Fax:212-305-9480
Practice Address - Street 1:3959 BROADWAY, 2ND FLOOR
Practice Address - Street 2:CHN-N
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2739
Practice Address - Country:US
Practice Address - Phone:212-342-8585
Practice Address - Fax:877-316-6162
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP01137208600000X
NJ25MA102917002086S0120X
NY2800802086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04240768Medicaid