Healthcare Provider Details

I. General information

NPI: 1962501387
Provider Name (Legal Business Name): VINCENT ROVITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 BAY RIDGE PKWY
BROOKLYN NY
11209-2403
US

IV. Provider business mailing address

237 BAY RIDGE PKWY
BROOKLYN NY
11209-2403
US

V. Phone/Fax

Practice location:
  • Phone: 718-748-7100
  • Fax: 718-748-0749
Mailing address:
  • Phone: 718-748-7100
  • Fax: 718-748-0749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number128440
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: