Healthcare Provider Details

I. General information

NPI: 1245666247
Provider Name (Legal Business Name): BRANDEN ROGER VUOLO RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 1ST ST
MINEOLA NY
11501-3957
US

IV. Provider business mailing address

127 PINEWOODS CRES
MIDDLE ISLAND NY
11953-1582
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-0333
  • Fax:
Mailing address:
  • Phone: 516-242-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number016620
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: