Provider Demographics
NPI:1982784161
Name:VITOLO, JOSEPH ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
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 1:45 HITHERBROOK ROAD
Mailing Address - Street 2:
Mailing Address - City:HEAD OF THE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11780
Mailing Address - Country:US
Mailing Address - Phone:631-265-7744
Mailing Address - Fax:631-862-3617
Practice Address - Street 1:48 ROUTE 25A, SUITE 308
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-265-7744
Practice Address - Fax:631-862-3617
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167973-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE62415Medicare UPIN