Provider Demographics
NPI:1710301262
Name:WADCAN, VINCENT J
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:J
Last Name:WADCAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MOUNT RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1161
Mailing Address - Country:US
Mailing Address - Phone:845-238-2512
Mailing Address - Fax:718-918-7526
Practice Address - Street 1:1 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-5838
Practice Address - Country:US
Practice Address - Phone:718-618-7525
Practice Address - Fax:718-618-7526
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039652-011835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric