Provider Demographics
NPI:1588851364
Name:VITOLO, DOMINICK (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINICK
Middle Name:
Last Name:VITOLO
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 1:12 INDIAN COVE RD
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-4439
Mailing Address - Country:US
Mailing Address - Phone:914-698-3058
Mailing Address - Fax:914-698-3058
Practice Address - Street 1:12 INDIAN COVE RD
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-4439
Practice Address - Country:US
Practice Address - Phone:914-698-3058
Practice Address - Fax:914-698-3058
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131463-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33A651Medicare PIN
NYB13115Medicare UPIN