Provider Demographics
NPI:1194719815
Name:MARRONE, VINCENT (MD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:MARRONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WEBSTER AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1361
Mailing Address - Country:US
Mailing Address - Phone:845-452-9800
Mailing Address - Fax:845-452-7691
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-452-9800
Practice Address - Fax:845-452-7691
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132343174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00700349Medicaid
NYVM03V69710OtherEMPIRE BLUE CROSS BLUE SHIELD
NYVM03V69710OtherEMPIRE BLUE CROSS BLUE SHIELD
NV66A413Medicare ID - Type Unspecified
NY66A41JW811Medicare PIN
NY00700349Medicaid