MEDICARE: CIPRIANO N. VAMENTA III

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1659580660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CIPRIANO N. VAMENTA III

Provider Business Mailing Address
First Line	:	1756 ROUTE 9D
Second Line	:
City	:	COLD SPRING
State	:	NY
Zip	:	10516-2619
Country	:	US
Telephone Number	:	845-265-3664
Fax Number	:	845-265-4324

Provider Business Practice Location Address
First Line	:	1756 ROUTE 9D
Second Line	:
City	:	COLD SPRING
State	:	NY
Zip	:	10516-2619
Country	:	US
Telephone Number	:	845-265-3664
Fax Number	:	845-265-4324

Authorized Official
Title or Position	:	M.D.
Name	:	DR. CIPRIANO N VAMENTA III
Credential	:	M.D.
Telephone Number	:	845-265-3664

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	11/09/2007

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