Healthcare Provider Details

I. General information

NPI: 1699715151
Provider Name (Legal Business Name): VITO CHARLES QUATELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

973 EAST AVE
ROCHESTER NY
14607-2216
US

IV. Provider business mailing address

973 EAST AVE
ROCHESTER NY
14607-2216
US

V. Phone/Fax

Practice location:
  • Phone: 585-244-1000
  • Fax: 585-271-4786
Mailing address:
  • Phone: 585-244-1000
  • Fax: 585-271-4786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number147025
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number147025
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: