Provider Demographics
NPI:1699783548
Name:GERACI, VINCENT THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:THOMAS
Last Name:GERACI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1501 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2212
Mailing Address - Country:US
Mailing Address - Phone:631-835-8700
Mailing Address - Fax:631-689-2847
Practice Address - Street 1:1501 STONY BROOK RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2212
Practice Address - Country:US
Practice Address - Phone:631-835-8700
Practice Address - Fax:631-689-2847
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5D6741Medicare ID - Type Unspecified
H31477Medicare UPIN