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NPI Code Detail

MEDICARE: VINCENT CONNORS RPA

MEDICARE: VINCENT CONNORS RPA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant001414-1NY

General Provider Information

NPI Number : 1124231402
Entity Type Code : Individual
Provider Name (Legal Business Name) : VINCENT CONNORS RPA
Provider Business Mailing Address
First Line : 12 S LITTLE WOLF RD
Second Line :
City : TUPPER LAKE
State : NY
Zip : 12986-1220
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2445 STATE ROUTE 30
Second Line :
City : TUPPER LAKE
State : NY
Zip : 12986-2502
Country : US
Telephone Number : 518-359-3311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2007
Last Update Date : 07/08/2007

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Directions to “ VINCENT CONNORS RPA” Practice Location

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