MEDICARE: VINCENT M. D'AMICO, M.D., 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	207V00000X	Obstetrics & Gynecology Physician	107159	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1457324923	OTHER	NY	NPI1

General Provider Information

NPI Number	:	1629375860
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VINCENT M. D'AMICO, M.D., P.C.

Provider Business Mailing Address
First Line	:	45 TOPLAND RD
Second Line	:
City	:	HARTSDALE
State	:	NY
Zip	:	10530-3001
Country	:	US
Telephone Number	:	914-428-4400
Fax Number	:	914-948-3509

Provider Business Practice Location Address
First Line	:	15 NORTH BROADWAY
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-2222
Country	:	US
Telephone Number	:	914-328-8444
Fax Number	:	914-428-7696

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VINCENT MARIO D'AMICO
Credential	:	M.D.
Telephone Number	:	914-428-4400

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	04/05/2011

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