Provider Demographics
NPI:1982617635
Name:ANSANELLI, VINCENT W (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:W
Last Name:ANSANELLI
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 1:100 MANETTO HILL ROAD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-938-4686
Mailing Address - Fax:516-938-4722
Practice Address - Street 1:100 MANETTO HILL ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:516-938-4686
Practice Address - Fax:516-938-4722
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077169-1208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
131965POtherHIP
0027454OtherGHI PPO
26387OtherAETNA
1C6124OtherHEALTHNET
00000076877OtherGHI HMO
AS1109OtherOXFORD
02004278OtherRAILROAD MEDICARE
2173633OtherOXFORD AMB SURG GRP
AA72048OtherMDNY
ANC1635OtherOXFORD AMB SURG
26387OtherAETNA
AA72048OtherMDNY