Healthcare Provider Details

I. General information

NPI: 1447401351
Provider Name (Legal Business Name): JOSEPH RYAN VENDITTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 SUNSET DR SUITE 401
SOUTH MIAMI FL
33143-5028
US

IV. Provider business mailing address

6141 SUNSET DR SUITE 401
SOUTH MIAMI FL
33143-5028
US

V. Phone/Fax

Practice location:
  • Phone: 973-975-3111
  • Fax:
Mailing address:
  • Phone: 973-975-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME113448
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: