=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407288152
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JEROME B. VINCENTE M.D.P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2013
-----------------------------------------------------
Last Update Date | 08/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 JFK DRIVE
-----------------------------------------------------
City | ATLANTIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33462-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-967-2200
-----------------------------------------------------
Fax | 561-967-0858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 115 JFK DRIVE
-----------------------------------------------------
City | ATLANTIS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33462-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-967-2200
-----------------------------------------------------
Fax | 561-967-0858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JEROME B VINCENTE
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 561-967-2200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME0045602
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------