Provider Demographics
NPI:1518923135
Name:MERCURIO, VITO ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:VITO
Middle Name:ANTHONY
Last Name:MERCURIO
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 1:285 SILLS RD
Mailing Address - Street 2:BUILDING #14
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4869
Mailing Address - Country:US
Mailing Address - Phone:631-447-8300
Mailing Address - Fax:631-447-8872
Practice Address - Street 1:285 SILLS RD
Practice Address - Street 2:BUILDING #14
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4869
Practice Address - Country:US
Practice Address - Phone:631-447-8300
Practice Address - Fax:631-447-8872
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1880531207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01776530Medicaid
NY49J751Medicare ID - Type Unspecified
NY01776530Medicaid