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General NPI Number Information
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NPI Number | 1174851414
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Entity Type | Organization
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Legal Business Name | ANTO VINCETIC DPM PC
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 06/21/2010
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Provider Practice Location Address
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Address Line | 3626 E TREMONT AVE SUITE 102
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City | BRONX
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State | NY
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Zip | 10465-2030
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Country | US
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Telephone | 718-409-0400
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Fax | 718-597-8962
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Provider Business Mailing Address
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Address Line | 21455 JAMAICA AVE
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City | QUEENS VILLAGE
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State | NY
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Zip | 11428-1733
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Country | US
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Telephone | 718-347-0494
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Fax | 718-347-6793
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | ANTO VINCETIC
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Credential | D.P.M
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Telephone | 718-347-0494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 005796
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License Number State | NY
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