Healthcare Provider Details

I. General information

NPI: 1003804394
Provider Name (Legal Business Name): ANTO VINCETIC DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 07/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3626 E TREMONT AVE STE 102
BRONX NY
10465-2030
US

IV. Provider business mailing address

3626 E TREMONT AVE STE 102
BRONX NY
10465
US

V. Phone/Fax

Practice location:
  • Phone: 718-409-0400
  • Fax: 718-518-1281
Mailing address:
  • Phone: 718-409-0400
  • Fax: 718-518-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number005796
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: