Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 205528 | NY |
Y | 207Q00000X | Family Doctor | 205528 | NY |
NPI | 1154402030 |
---|---|
Provider Name | Joseph Vitoulis |
First Address | Lynbrook, NY 11563 |
Second Address | Lynbrook, NY 11563 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 13/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01918905 | (05) | NY |
H26750 | (02) |