Healthcare Provider Details

I. General information

NPI: 1316389174
Provider Name (Legal Business Name): VINCENT W ANSANELLI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2013
Last Update Date: 07/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD SUITE 210
PLAINVIEW NY
11803
US

IV. Provider business mailing address

100 MANETTO HILL RD SUITE 210
PLAINVIEW NY
11803-1311
US

V. Phone/Fax

Practice location:
  • Phone: 516-938-4686
  • Fax:
Mailing address:
  • Phone: 516-938-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: VINCENT W ANSANELLI JR.
Title or Position: DOCTOR
Credential: M.D., F.A.C.S., P.C.
Phone: 516-938-4686