1801843370 NPI number — FREDERIC J. VAGNINI, MD, FACS

Table of content: (NPI 1801843370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801843370 NPI number — FREDERIC J. VAGNINI, MD, FACS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FREDERIC J. VAGNINI, MD, FACS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1801843370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1991 MARCUS AVE
Provider Second Line Business Mailing Address:
SUITE M107
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-2057
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-222-2288
Provider Business Mailing Address Fax Number:
516-745-0976

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1991 MARCUS AVE
Provider Second Line Business Practice Location Address:
SUITE M107
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-2057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-222-2288
Provider Business Practice Location Address Fax Number:
516-745-0976
Provider Enumeration Date:
05/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VAGNINI
Authorized Official First Name:
FREDERIC
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
516-222-2288

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  091891 , 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)

  • Identifier: 091891 . This is a "NYS MEDICAL LIC #" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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