Provider Demographics
NPI:1801843370
Name:FREDERIC J. VAGNINI, MD, FACS
Entity Type:Organization
Organization Name:FREDERIC J. VAGNINI, MD, FACS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAGNINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-222-2288
Mailing Address - Street 1:1991 MARCUS AVE
Mailing Address - Street 2:SUITE M107
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2057
Mailing Address - Country:US
Mailing Address - Phone:516-222-2288
Mailing Address - Fax:516-745-0976
Practice Address - Street 1:1991 MARCUS AVE
Practice Address - Street 2:SUITE M107
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2057
Practice Address - Country:US
Practice Address - Phone:516-222-2288
Practice Address - Fax:516-745-0976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091891207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY091891OtherNYS MEDICAL LIC #
NYB19896Medicare UPIN
NY091891OtherNYS MEDICAL LIC #