Basic Information
| Provider Information | |||||||||
| NPI: | 1578765608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DURON | ||||||||
| FirstName: | VINCENT | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27036 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100877036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059576 | ||||||||
| FaxNumber: | 2123059480 | ||||||||
| Practice Location | |||||||||
| Address1: | 3959 BROADWAY, 2ND FLOOR | ||||||||
| Address2: | CHN-N | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100322739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123428585 | ||||||||
| FaxNumber: | 8773166162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | LP01137 | RI | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | 25MA10291700 | NJ | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 280080 | NY | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 04240768 | 05 | NY | MEDICAID |