Healthcare Provider Details

I. General information

NPI: 1871423194
Provider Name (Legal Business Name): ADAM VITOULIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 ROUTE 17K
NEWBURGH NY
12550-3922
US

IV. Provider business mailing address

53 ROUTE 17K
NEWBURGH NY
12550-3922
US

V. Phone/Fax

Practice location:
  • Phone: 845-560-3090
  • Fax:
Mailing address:
  • Phone: 845-560-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number14000084826
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: