Healthcare Provider Details

I. General information

NPI: 1316934573
Provider Name (Legal Business Name): BRUCE S. ZITKUS EDD, ANP-BC, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VISITING NURSE SERVICE & HOSPICE OF SUFFOLK, INC. 505 MAIN STREET
NORTHPORT NY
11768
US

IV. Provider business mailing address

87 CALVIN AVE
SYOSSET NY
11791-2136
US

V. Phone/Fax

Practice location:
  • Phone: 631-439-2740
  • Fax: 631-912-1417
Mailing address:
  • Phone: 631-330-9693
  • Fax: 949-209-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number301909
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number421621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: