Provider Demographics
NPI:1659161073
Name:VIGLIOTTI, MICHAEL ANTHONY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:VIGLIOTTI
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Gender:
Credentials:NURSE PRACTITIONER
Other - Prefix:
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Mailing Address - Street 1:2627 HYLAN BLVD.
Mailing Address - Street 2:SUITE C, LOWER LEVEL
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306
Mailing Address - Country:US
Mailing Address - Phone:718-351-1136
Mailing Address - Fax:718-667-9711
Practice Address - Street 1:2627 HYLAN BLVD.
Practice Address - Street 2:SUITE C, LOWER LEVEL
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306
Practice Address - Country:US
Practice Address - Phone:718-351-1136
Practice Address - Fax:718-667-9711
Is Sole Proprietor?:No
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY356361363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care