MEDICARE: ANTO VINCETIC DPM PC

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
1	213ES0103X	Foot & Ankle Surgery Podiatrist	005796	NY

General Provider Information

NPI Number	:	1174851414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTO VINCETIC DPM PC

Provider Business Mailing Address
First Line	:	21455 JAMAICA AVE
Second Line	:
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-1733
Country	:	US
Telephone Number	:	718-347-0494
Fax Number	:	718-347-6793

Provider Business Practice Location Address
First Line	:	3626 E TREMONT AVE
Second Line	:	SUITE 102
City	:	BRONX
State	:	NY
Zip	:	10465-2030
Country	:	US
Telephone Number	:	718-409-0400
Fax Number	:	718-597-8962

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	ANTO VINCETIC
Credential	:	D.P.M
Telephone Number	:	718-347-0494

Provider Enumeration Date	:	11/25/2009
Last Update Date	:	06/21/2010

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