Provider Demographics
NPI:1851349856
Name:DEVINCENZO, NICHOLAS A (PA)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:A
Last Name:DEVINCENZO
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Gender:M
Credentials:PA
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Mailing Address - Street 1:800 POLY PL
Mailing Address - Street 2:DEPT. OF NEPHROLOGY (111F)
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7104
Mailing Address - Country:US
Mailing Address - Phone:718-630-3752
Mailing Address - Fax:718-630-3763
Practice Address - Street 1:800 POLY PL
Practice Address - Street 2:MEDICAL SERVICE (111)
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7104
Practice Address - Country:US
Practice Address - Phone:718-630-3766
Practice Address - Fax:718-630-3763
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-13
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Provider Licenses
StateLicense IDTaxonomies
NYNYS000781363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical