Provider Demographics
NPI:1700996758
Name:MACALUSO, VINCENT FRANCIS (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:FRANCIS
Last Name:MACALUSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:215 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1111
Mailing Address - Country:US
Mailing Address - Phone:718-224-8243
Mailing Address - Fax:
Practice Address - Street 1:1575 HILLSIDE AVE
Practice Address - Street 2:LL#1
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2501
Practice Address - Country:US
Practice Address - Phone:516-498-2300
Practice Address - Fax:516-498-2301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2105622084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG70899Medicare UPIN
NY00S931Medicare ID - Type Unspecified