Healthcare Provider Details

I. General information

NPI: 1437147493
Provider Name (Legal Business Name): VINCENT JOHN VIGORITA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 SANDPIPER LANE
AMAGANSETT NY
11930-1845
US

IV. Provider business mailing address

PO BOX 1845
AMAGANSETT NY
11930-1845
US

V. Phone/Fax

Practice location:
  • Phone: 631-267-8726
  • Fax: 631-267-2296
Mailing address:
  • Phone: 631-267-8726
  • Fax: 631-267-2296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number135450
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: