Provider Demographics
NPI:1922777341
Name:VINES, MARIA (BS)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VINES
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 KNOLLWOOD RD STE 108
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-1916
Mailing Address - Country:US
Mailing Address - Phone:225-335-8750
Mailing Address - Fax:
Practice Address - Street 1:399 KNOLLWOOD RD STE 108
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-1916
Practice Address - Country:US
Practice Address - Phone:225-335-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
246ZE0600XOtherSPECIALIST/TECHNOLOGIST, OTHER-ELECTRONEURODIAGNOSTIC