Provider Demographics
NPI:1609149640
Name:WILLIAM J. VENDITTELLI DC PC
Entity Type:Organization
Organization Name:WILLIAM J. VENDITTELLI DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:VENDITTELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-268-1976
Mailing Address - Street 1:71-36 110TH ST
Mailing Address - Street 2:SUITE 1L
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-268-1976
Mailing Address - Fax:718-544-9365
Practice Address - Street 1:71-36 110TH ST
Practice Address - Street 2:SUITE 1L
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-268-1976
Practice Address - Fax:718-544-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02822535Medicaid
NY02822535Medicaid
T31740Medicare UPIN