Basic Information
Provider Information
NPI: 1003002809
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GRAZIANO
FirstName: VINCENT
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 45 W 11TH ST
Address2: APT 1A
City: NEW YORK
State: NY
PostalCode: 100118664
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 45 W 11TH ST
Address2: APT 1A
City: NEW YORK
State: NY
PostalCode: 100118664
CountryCode: US
TelephoneNumber: 6464072044
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/15/2007
LastUpdateDate: 09/15/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2085R0202X00243641NYY Allopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology

No ID Information.


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