Provider Demographics
NPI:1780698290
Name:VACEK, JAMES J (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:VACEK
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:99 EAST STATE STREET
Mailing Address - Street 2:PO BOX 1250
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078
Mailing Address - Country:US
Mailing Address - Phone:518-775-4201
Mailing Address - Fax:518-775-4225
Practice Address - Street 1:99 EAST STATE STREET
Practice Address - Street 2:MAB-GR01
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078
Practice Address - Country:US
Practice Address - Phone:518-775-4201
Practice Address - Fax:518-775-4225
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-01-22
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Provider Licenses
StateLicense IDTaxonomies
NY138653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10026183OtherCDPHP
NY00617152Medicaid
NY950995OtherMVP HEALTHPLAN
NY000401141002OtherBSH NE NY
NY950995OtherMVP HEALTHPLAN
NYB81967Medicare UPIN