Healthcare Provider Details

I. General information

NPI: 1952249989
Provider Name (Legal Business Name): ANDREW A VINCENT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 N SALINA ST
SYRACUSE NY
13203-1755
US

IV. Provider business mailing address

518 JAMES ST
SYRACUSE NY
13203-2238
US

V. Phone/Fax

Practice location:
  • Phone: 315-401-4443
  • Fax:
Mailing address:
  • Phone: 315-484-6024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCRPA-6767
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: