Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213ES0103X | Foot & Ankle Surgery | 330 | NC |
Y | 213ES0103X | Foot & Ankle Surgery | N005120 | NY |
N | 213ES0103X | Foot & Ankle Surgery | SC004333 | PA |
NPI | 1003888298 |
---|---|
Provider Name | Dr. George Robert Vito |
First Address | Le Roy, NY 14482-1530 |
Second Address | Le Roy, NY 14482 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 19/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03157146 | (05) | NY |
5917998 | (05) | NC |
J300533759 | MEDICARE PTAN (01) | NY |