Healthcare Provider Details

I. General information

NPI: 1467444208
Provider Name (Legal Business Name): VINCENT J. CARSILLO II D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 HACKETT BLVD
ALBANY NY
12209
US

IV. Provider business mailing address

62 HACKETT BLVD
ALBANY NY
12209-1718
US

V. Phone/Fax

Practice location:
  • Phone: 518-434-2244
  • Fax: 518-434-4659
Mailing address:
  • Phone: 518-434-2244
  • Fax: 518-434-4659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number232172-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: