Healthcare Provider Details

I. General information

NPI: 1326246380
Provider Name (Legal Business Name): JEFFREY M VINOCUR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 11/04/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CHURCH ST
NEW HAVEN CT
06510-1805
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 635
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2022
  • Fax: 203-737-2786
Mailing address:
  • Phone: 585-275-6108
  • Fax: 585-442-0104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number69142
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number290097
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number270097
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number270097
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number69142
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: