Provider Demographics
NPI:1770641169
Name:VANVYNCK, WILLIAM JOSEPH (DPT)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOSEPH
Last Name:VANVYNCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 E MAIN ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2939
Mailing Address - Country:US
Mailing Address - Phone:631-427-7600
Mailing Address - Fax:631-427-7636
Practice Address - Street 1:175 E MAIN ST
Practice Address - Street 2:SUITE 110
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2939
Practice Address - Country:US
Practice Address - Phone:631-427-7600
Practice Address - Fax:631-427-7636
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY704749OtherMPN
NYA100145309Medicare PIN