Doctor Name: | JOSEPH VITOULIS |
NPI Number: | 1154402030 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | 205528 |
Business Practice Address: | 120 Broadway Lynbrook, NY - 11563 |
Business Phone Number: | 5165930406 |
Business Fax Number: | 5165930406 |
Mailing Address: | 120 Broadway, LYNBROOK |
State: | NY |
Postal Code: | 11563 |
Phone Number: | 5165930406 |
Fax Number: | 5165930406 |
NPI Enumeration Date: | 10/18/2006 |
NPI Last Update Date: | 08/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204D00000X |
License Number: | 205528 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NY |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine & OMM |
Taxonomy Specialization: | |
Taxonomy Definition: |