=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184818528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY J VECCHIA M.D. PC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/29/2007
-----------------------------------------------------
Last Update Date | 08/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41-15 162ND ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11358-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-762-6640
-----------------------------------------------------
Fax | 718-762-6635
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 41-15 162ND ST
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11358-4124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-762-6640
-----------------------------------------------------
Fax | 718-762-6635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ANTHONY JOSEPH VECCHIA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-762-5540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 232075
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QE0002X
-----------------------------------------------------
Taxonomy Name | Emergency Care Clinic/Center
-----------------------------------------------------
License Number | 232075
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------