Healthcare Provider Details

I. General information

NPI: 1366555849
Provider Name (Legal Business Name): RICHARD ZITO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 BAYVIEW AVE
EAST ISLIP NY
11730-3118
US

IV. Provider business mailing address

69 BAYVIEW AVE
EAST ISLIP NY
11730-3118
US

V. Phone/Fax

Practice location:
  • Phone: 631-446-1924
  • Fax: 631-277-0899
Mailing address:
  • Phone: 631-446-1924
  • Fax: 631-277-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number191152
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: