Provider Demographics
NPI:1609067545
Name:VITREORETINAL SURGEONS LLC
Entity Type:Organization
Organization Name:VITREORETINAL SURGEONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:S
Authorized Official - Last Name:REPPUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-792-6291
Mailing Address - Street 1:65 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5640
Mailing Address - Country:US
Mailing Address - Phone:203-792-6191
Mailing Address - Fax:203-744-3669
Practice Address - Street 1:1317 3RD AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2995
Practice Address - Country:US
Practice Address - Phone:203-792-6191
Practice Address - Fax:203-744-3669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT028973207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01195317Medicaid
CT001289736Medicaid
NY01195317Medicaid
D80778Medicare UPIN
NY30E001Medicare PIN