Individual provider Active NPI

Carl Eugene Vinciguerra, MD

  • General Practice Physician
  • Ozone Park, NY
National Provider Identifier
1760451033
Registry record updated Jan 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
155025 Issued in NY
Practice address
97-15 101St Ave
Ozone Park, NY 11416-2523
Phone
(718) 849-7922
Fax
(718) 849-7922
NPI assigned
Mar 17, 2006
Last updated
Jan 6, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 155025 NY Primary

Addresses

Primary practice location

97-15 101St Ave
Ozone Park, NY 11416-2523

Mailing address

9715 101St Ave
Ozone Park, NY 11416-2523
Phone (718) 849-7922

Other identifiers 1

IdentifierTypeStateIssuer
00830328MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091222000127 NY Practitioner - General Practice 7810037900 Practice locations: Ozone Park, NY

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

9715 101St Ave
Ozone Park, NY 11416-2523
Phone (718) 849-7922

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
155025NYMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Vincent Evangelista, DPM PC CurrentSince Dec 1, 2019 Accepting new patients

Locations

9715 101st Ave
Ozone Park, NY 11416
Phone (718) 848-5700

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578268800000",
    "number": "1760451033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9715 101ST AVE",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114162523",
            "telephone_number": "718-849-7922",
            "fax_number": "718-849-7922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97-15 101ST AVE",
            "city": "OZONE PARK",
            "state": "NY",
            "postal_code": "114162523",
            "telephone_number": "718-849-7922",
            "fax_number": "718-849-7922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCIGUERRA",
        "first_name": "CARL",
        "middle_name": "EUGENE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NY",
            "license": "155025",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00830328",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ozone Park, NY

Sources for this page

Verify at the official NPI Registry.