1780611228 NPI number — MR. VINCENT JOSEPH MONTAGNINO RPA

Table of content: MR. VINCENT JOSEPH MONTAGNINO RPA (NPI 1780611228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780611228 NPI number — MR. VINCENT JOSEPH MONTAGNINO RPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTAGNINO
Provider First Name:
VINCENT
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
RPA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780611228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT.
Provider Second Line Business Mailing Address:
ST. MARY'S HOSPITAL AT AMSTERDAM
Provider Business Mailing Address City Name:
AMSTERDAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-841-7430
Provider Business Mailing Address Fax Number:
518-841-7121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
84 E. STATE ST
Provider Second Line Business Practice Location Address:
ST. MARY'S HOSPITAL, GLOVERSVILLE FAMILY HEALTH CENTER
Provider Business Practice Location Address City Name:
GLOVERSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-773-8894
Provider Business Practice Location Address Fax Number:
518-773-8125
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  001484 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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