Healthcare Provider Details

I. General information

NPI: 1710301262
Provider Name (Legal Business Name): MR. VINCENT J WADCAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 02/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 E TREMONT AVE
BRONX NY
10453-5838
US

IV. Provider business mailing address

27 MOUNT RIDGE CT
MONROE NY
10950-1161
US

V. Phone/Fax

Practice location:
  • Phone: 718-618-7525
  • Fax: 718-618-7526
Mailing address:
  • Phone: 845-238-2512
  • Fax: 718-918-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number039652-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: