Provider Demographics
NPI:1255303202
Name:VIZIOLI, LOUIS DOMINICK (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:DOMINICK
Last Name:VIZIOLI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1030
Mailing Address - Country:US
Mailing Address - Phone:914-849-7180
Mailing Address - Fax:914-849-7199
Practice Address - Street 1:33 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1030
Practice Address - Country:US
Practice Address - Phone:914-849-7180
Practice Address - Fax:914-849-7199
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1755761207R00000X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01400586Medicaid
F30353Medicare UPIN
NY36K571Medicare ID - Type Unspecified