Provider Demographics
NPI:1750359444
Name:VENDITTO, JOHN A (MD,MBA,FACC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:VENDITTO
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Gender:M
Credentials:MD,MBA,FACC
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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
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2014-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY185317207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY91K62FL311Medicare PIN