Provider Demographics
NPI:1851315634
Name:DE VINCENTIS, JOSEPH ANTHONY (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:DE VINCENTIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 SOUTHWESTERN BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1239
Mailing Address - Country:US
Mailing Address - Phone:716-677-2601
Mailing Address - Fax:716-677-0340
Practice Address - Street 1:3065 SOUTHWESTERN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127
Practice Address - Country:US
Practice Address - Phone:716-677-2601
Practice Address - Fax:716-677-0340
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002646213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000507384013OtherBCBS
NY8905253OtherINDEPENDENT HEALTH
NY000507384012OtherBCBS
NY000507384015OtherBCBS
NY00607814Medicaid
NY00010250307OtherUNIVERA
NY000507384014OtherBCBS
NYT26053Medicare UPIN
NY000507384014OtherBCBS