Provider Demographics
NPI:1760451033
Name:VINCIGUERRA, CARL EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:EUGENE
Last Name:VINCIGUERRA
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 1:9715 101ST AVE
Mailing Address - Street 2:
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-2523
Mailing Address - Country:US
Mailing Address - Phone:718-849-7922
Mailing Address - Fax:718-849-7922
Practice Address - Street 1:97-15 101ST AVE
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-2523
Practice Address - Country:US
Practice Address - Phone:718-849-7922
Practice Address - Fax:718-849-7922
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155025208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00830328Medicaid
NY00830328Medicaid
NY60263Medicare ID - Type Unspecified