Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 135450 | NY |
NPI | 1437147493 |
---|---|
Provider Name | Dr. Vincent John Vigorita |
First Address | Amagansett, NY 11930-1845 |
Second Address | Amagansett, NY 11930-1845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 08/07/2007 |