Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MA03255700 | NJ |
NPI | 1205928777 |
---|---|
Provider Name | John Floyd Vigorita |
First Address | Summit, NJ 07901-3570 |
Second Address | Summit, NJ 07901-3570 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E73297 | (02) | NJ |
MA03255700 | LICENSE (01) | NJ |