Basic Information
| Provider Information | |||||||||
| NPI: | 1063493856 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | VAGNINI | ||||||||
| FirstName: | VINCENT | ||||||||
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| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 PINE CRST | ||||||||
| Address2: | |||||||||
| City: | BALLSTON LAKE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120199248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188995319 | ||||||||
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| Practice Location | |||||||||
| Address1: | NEW YORK ONCOLOGY HEMATOLOGY | ||||||||
| Address2: | 317 SOUTH MANNING BLVD. SUIT 310 | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184890044 | ||||||||
| FaxNumber: | 5184893591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 035685 | NY | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.