Provider Demographics
NPI:1962943977
Name:VINTAGECOM
Entity type:Organization
Organization Name:VINTAGECOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:SKEETE
Authorized Official - Suffix:
Authorized Official - Credentials:AAS
Authorized Official - Phone:718-840-9004
Mailing Address - Street 1:1502 E 34TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-2602
Mailing Address - Country:US
Mailing Address - Phone:718-840-9004
Mailing Address - Fax:347-462-9879
Practice Address - Street 1:1502 E 34TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2602
Practice Address - Country:US
Practice Address - Phone:718-840-9004
Practice Address - Fax:347-462-9879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-10
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty