Provider Demographics
NPI:1003888298
Name:VITO, GEORGE ROBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:ROBERT
Last Name:VITO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:LE ROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482-1530
Mailing Address - Country:US
Mailing Address - Phone:585-797-5828
Mailing Address - Fax:158-567-2910
Practice Address - Street 1:8745 LAKE STREET RD
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482
Practice Address - Country:US
Practice Address - Phone:585-297-9761
Practice Address - Fax:585-672-9100
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC330213ES0103X
PASC004333213ES0103X
NYN005120213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5917998Medicaid
NYJ300533759OtherMEDICARE PTAN
NY03157146Medicaid
NYJ400005764Medicare PIN
NC2437020Medicare PIN