Healthcare Provider Details

I. General information

NPI: 1205928777
Provider Name (Legal Business Name): JOHN FLOYD VIGORITA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 OVERLOOK RD SUITE 101
SUMMIT NJ
07901-3570
US

IV. Provider business mailing address

33 OVERLOOK RD SUITE 101
SUMMIT NJ
07901-3570
US

V. Phone/Fax

Practice location:
  • Phone: 908-273-1112
  • Fax: 908-273-1146
Mailing address:
  • Phone: 908-273-1112
  • Fax: 908-273-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberMA03255700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: