MEDICARE: EDDY J. VINCENT PHYSICIAN,P.C.

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	174400000X	Specialist	133188	NY

General Provider Information

NPI Number	:	1366989790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDDY J. VINCENT PHYSICIAN,P.C.

Provider Business Mailing Address
First Line	:	1164 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5418
Country	:	US
Telephone Number	:	718-493-6964
Fax Number	:

Provider Business Practice Location Address
First Line	:	1164 NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-5418
Country	:	US
Telephone Number	:	718-493-6964
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDDY J VINCENT
Credential	:	M.D.
Telephone Number	:	718-493-6964

Provider Enumeration Date	:	01/24/2017
Last Update Date	:	01/24/2017

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