Healthcare Provider Details

I. General information

NPI: 1972504553
Provider Name (Legal Business Name): VICKI IANNOTTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PONDFIELD ROAD, SUITE 301B
BRONXVILLE NY
10708
US

IV. Provider business mailing address

1 PONDFIELD ROAD, SUITE 301B
BRONXVILLE NY
10708
US

V. Phone/Fax

Practice location:
  • Phone: 646-531-0228
  • Fax: 212-305-5486
Mailing address:
  • Phone: 646-531-0228
  • Fax: 212-305-5486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number195452
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: