Provider Demographics
NPI:1932121969
Name:GIOVINAZZO, VINCENT JEROME (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JEROME
Last Name:GIOVINAZZO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 SEAVIEW AVE
Mailing Address - Street 2:SUITE 5 STATEN ISLAND UNIVERSITY HOSPITAL
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-6283
Mailing Address - Fax:718-226-6197
Practice Address - Street 1:242 MASON AVE
Practice Address - Street 2:SUITE 5 MEDICAL ARTS PAVILION RETINA CENTER
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3408
Practice Address - Country:US
Practice Address - Phone:718-226-6283
Practice Address - Fax:718-226-6197
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137304207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00696433Medicaid
18757Medicare UPIN
NY70A263Medicare ID - Type Unspecified