Provider Demographics
NPI:1528255825
Name:VINCENT P. DETRINIS, D.C., P.C.
Entity type:Organization
Organization Name:VINCENT P. DETRINIS, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DETRINIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-689-2993
Mailing Address - Street 1:100 N COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-1300
Mailing Address - Country:US
Mailing Address - Phone:631-689-2993
Mailing Address - Fax:631-689-2994
Practice Address - Street 1:100 N COUNTRY RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-1300
Practice Address - Country:US
Practice Address - Phone:631-689-2993
Practice Address - Fax:631-689-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX04504111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX25681Medicare PIN