Vincent Connors, RPA
Individual provider Active NPI Physician Assistant · Tupper Lake, NY
NPI 1124231402 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1124231402
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 001414-1 (NY)
- Practice address
- 2445 State Route 30
Tupper Lake, NY 12986-2502 - Phone
- (518) 359-3311
- NPI assigned
- May 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001414 | NY | MD | Acupuncturist |
| 001414-1 | NY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of New York Comptrollers Office | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 001414-1 | NY | Yes |
Addresses
Primary practice location
2445 State Route 30
Tupper Lake, NY 12986-2502
Mailing address
12 S Little Wolf Rd
Tupper Lake, NY 12986-1220
Other providers in Tupper Lake, NY
- Stephanie Cassell
- Rafael Castellanos
- Kristen Nichole Churco
- Lisa Colbert
- Jules Comeau
- Eileen Dattola
- Margaret D Dechene
- Haley Mae Del Duca
- Carol Dimond
- Janelle Edwards
All providers in Tupper Lake, NY · Physician Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.