Provider Demographics
NPI: | 1952328775 |
---|---|
Name: | VINCENT J GULFO MD PC |
Entity Type: | Organization |
Organization Name: | VINCENT J GULFO MD PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | VINCENT |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | GULFO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 845-987-7260 |
Mailing Address - Street 1: | PO BOX 1068 |
Mailing Address - Street 2: | |
Mailing Address - City: | WARWICK |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 10990-8067 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 845-987-7260 |
Mailing Address - Fax: | 845-988-5749 |
Practice Address - Street 1: | 153 ROUTE 94 S |
Practice Address - Street 2: | |
Practice Address - City: | WARWICK |
Practice Address - State: | NY |
Practice Address - Zip Code: | 10990-3658 |
Practice Address - Country: | US |
Practice Address - Phone: | 845-987-7260 |
Practice Address - Fax: | 845-988-5749 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-16 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | 28567 | 204C00000X, 204D00000X, 208100000X, 2081P0004X, 2081P0010X, 2081P2900X, 2081S0010X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Not Answered | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | Group - Single Specialty | |
Not Answered | 204D00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine & OMM | Group - Single Specialty | |
Not Answered | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Single Specialty | |
Not Answered | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | Group - Single Specialty |
Not Answered | 2081P0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pediatric Rehabilitation Medicine | Group - Single Specialty |
Not Answered | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Single Specialty |
Not Answered | 2081S0010X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Sports Medicine | Group - Single Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
E10662 | Medicare UPIN |