Provider Demographics
NPI:1922074616
Name:VITOLO, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
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 1:540 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:973-383-6236
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:973-383-6236
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46935174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE70893Medicare UPIN
NJ081576SZPMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE