Healthcare Provider Details

I. General information

NPI: 1174906440
Provider Name (Legal Business Name): MRS. GRACE JEAN VUOTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2015
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 CARMAN AVE
EAST ROCKAWAY NY
11518-1302
US

IV. Provider business mailing address

193 CARMAN AVE
EAST ROCKAWAY NY
11518-1302
US

V. Phone/Fax

Practice location:
  • Phone: 516-887-7556
  • Fax: 516-887-9045
Mailing address:
  • Phone: 516-887-7556
  • Fax: 516-887-9045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: