MEDICARE: MR. VINCENT JOHN CASERTA R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	032958	NY

General Provider Information

NPI Number	:	1336587773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. VINCENT JOHN CASERTA R.PH.

Provider Business Mailing Address
First Line	:	4802 10TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2916
Country	:	US
Telephone Number	:	718-283-1845
Fax Number	:	718-635-5777

Provider Business Practice Location Address
First Line	:	41 FAIRLAWN LOOP
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10308-3508
Country	:	US
Telephone Number	:	917-922-2842
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2013
Last Update Date	:	06/07/2013

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