Provider Demographics
NPI:1790074219
Name:VINCENT JOHN SENA, MD
Entity Type:Organization
Organization Name:VINCENT JOHN SENA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D. (OWNER)
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-766-5881
Mailing Address - Street 1:165 NORTH VILLAGE AVENUE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-766-5881
Mailing Address - Fax:516-594-0726
Practice Address - Street 1:165 NORTH VILLAGE AVENUE
Practice Address - Street 2:SUITE 140
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-766-5881
Practice Address - Fax:516-594-0726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158697208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01835125Medicaid
NYA64420Medicare UPIN