Healthcare Provider Details

I. General information

NPI: 1912954991
Provider Name (Legal Business Name): JOSEPH MC VITANZA PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

115 96TH ST 7B
BROOKLYN NY
11209-7520
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-6600
  • Fax: 718-630-2822
Mailing address:
  • Phone: 718-630-5407
  • Fax: 718-630-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number038922
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: