Active NPI
Vilma Biado Vicencio, PT
- Physical Therapist
- Middle Island, NY
National Provider Identifier
1104033489
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 011017-1
- Practice address
- 35 Longwood Rd
Middle Island, NY 11953-2045 - Phone
- (631) 924-0008
- NPI assigned
- May 17, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 011017-1 | NY | Primary |
Addresses
Primary practice location
35 Longwood Rd
Middle Island, NY 11953-2045
Mailing address
4 Susan Dr
Wading River, NY 11792-2130
Phone (631) 866-1900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 011017-1 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104033489",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 SUSAN DR",
"city": "WADING RIVER",
"state": "NY",
"postal_code": "117922130",
"telephone_number": "631-866-1900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "35 LONGWOOD RD",
"city": "MIDDLE ISLAND",
"state": "NY",
"postal_code": "119532045",
"telephone_number": "631-924-0008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICENCIO",
"first_name": "VILMA",
"middle_name": "BIADO",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "011017-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Middle Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.