Healthcare Provider Details

I. General information

NPI: 1295085702
Provider Name (Legal Business Name): CYNTHIA VUITTONET M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 HOBART ST
PERTH AMBOY NJ
08861-3396
US

IV. Provider business mailing address

275 HOBART ST
PERTH AMBOY NJ
08861-3396
US

V. Phone/Fax

Practice location:
  • Phone: 732-376-9333
  • Fax:
Mailing address:
  • Phone: 732-376-9333
  • Fax: 844-584-1477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberLP02680
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number262341
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10264700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: