Provider Demographics
NPI:1982673646
Name:BENEDETTO, VINCENT (PT, MS, ACSM H/FI)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:BENEDETTO
Suffix:
Gender:M
Credentials:PT, MS, ACSM H/FI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 E 100TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6274
Mailing Address - Country:US
Mailing Address - Phone:212-369-2040
Mailing Address - Fax:212-369-2949
Practice Address - Street 1:158 E 100TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6274
Practice Address - Country:US
Practice Address - Phone:212-369-2040
Practice Address - Fax:212-369-2949
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024223-1225100000X
NJ40QA01147300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ088602TYFMedicare ID - Type Unspecified
Q37680Medicare UPIN