Provider Demographics
NPI:1134266877
Name:JOHN A VENDITTO MD PC
Entity type:Organization
Organization Name:JOHN A VENDITTO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VENDITTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA, FACC
Authorized Official - Phone:516-626-0700
Mailing Address - Street 1:2200 NORTHERN BLVD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:GREENVALE
Mailing Address - State:NY
Mailing Address - Zip Code:11548-1220
Mailing Address - Country:US
Mailing Address - Phone:516-626-0700
Mailing Address - Fax:516-626-1190
Practice Address - Street 1:2200 NORTHERN BLVD
Practice Address - Street 2:SUITE 132
Practice Address - City:GREENVALE
Practice Address - State:NY
Practice Address - Zip Code:11548-1220
Practice Address - Country:US
Practice Address - Phone:516-626-0700
Practice Address - Fax:516-626-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2014-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY185317207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWFL311Medicare PIN