Provider Demographics
NPI:1881781979
Name:CAMPASANO, VINCENT (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CAMPASANO
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:656 NORTH WELLWOOD AVENUE SUITE G & H
Mailing Address - Street 2:PREMIER CARE
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-225-4227
Mailing Address - Fax:631-225-4229
Practice Address - Street 1:656 NORTH WELLWOOD AVE SUITE G & H
Practice Address - Street 2:PREMIERE CARE
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-225-4227
Practice Address - Fax:631-225-4229
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY228987207P00000X
NJ25MA09619200207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine