Most Relevant Information
Provider Data
| NPI Number: | 1003462193 |
| Provider Name: | REBECCA KELLY VICENTE PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363A00000X |
| Specialty: | Physician Assistant |
| License Number: | 024058 |
Most Important Dates
| Enumeration Date: | 08/14/2019 |
| Last Updated: | 06/09/2020 |
Provider Practice Location
300 COMMUNITY DR
MANHASSET
NY
110303816
Practice Location Phone/Fax
| Phone: | 5165620100 |
| Fax: |
Provider Mailing Location
9 BIRCHWOOD RD
OLD TAPPAN
NJ
076757102
Provider Mailing Phone/Fax
| Phone: | 2012818708 |
| Fax: |