Provider Demographics
NPI:1437349644
Name:JOHN VITOLO, M.D. P.C.
Entity Type:Organization
Organization Name:JOHN VITOLO, M.D. P.C.
Other - Org Name:SKYVIEW ORTHOPEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VITOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-300-1553
Mailing Address - Street 1:540 LAFAYETTE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3447
Mailing Address - Country:US
Mailing Address - Phone:973-300-1553
Mailing Address - Fax:
Practice Address - Street 1:540 LAFAYETTE RD
Practice Address - Street 2:SUITE D
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3447
Practice Address - Country:US
Practice Address - Phone:973-300-1553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ081567Medicare PIN