Provider Demographics
NPI:1487947537
Name:MINEO, VINCENZA (DPM)
Entity type:Individual
Prefix:
First Name:VINCENZA
Middle Name:
Last Name:MINEO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1368 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4303
Mailing Address - Country:US
Mailing Address - Phone:718-816-0237
Mailing Address - Fax:718-816-5465
Practice Address - Street 1:1368 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4303
Practice Address - Country:US
Practice Address - Phone:718-816-0237
Practice Address - Fax:718-816-5465
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00307800213E00000X
NY006495193400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes193400000XGroupSingle Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist