Provider Demographics
NPI:1548599418
Name:VITREORETINAL & UVEITIS SERVICES, PC
Entity Type:Organization
Organization Name:VITREORETINAL & UVEITIS SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAPOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-551-5427
Mailing Address - Street 1:PO BOX 1203
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-0486
Mailing Address - Country:US
Mailing Address - Phone:516-783-6692
Mailing Address - Fax:516-826-6196
Practice Address - Street 1:8212 151ST AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1761
Practice Address - Country:US
Practice Address - Phone:718-845-4400
Practice Address - Fax:718-738-8198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY166756207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01532214Medicaid
NY01620Medicare PIN