Healthcare Provider Details

I. General information

NPI: 1902874738
Provider Name (Legal Business Name): BENEDETTO BENNY VITULLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ENGLISH ROAD SUITE 10
ROCHESTER NY
14616-1600
US

IV. Provider business mailing address

1800 ENGLISH ROAD SUITE 10
ROCHESTER NY
14616-1600
US

V. Phone/Fax

Practice location:
  • Phone: 585-225-2525
  • Fax: 585-225-2626
Mailing address:
  • Phone: 585-225-2525
  • Fax: 585-225-2626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number198542
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number198542
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: