Healthcare Provider Details

I. General information

NPI: 1659161073
Provider Name (Legal Business Name): MICHAEL ANTHONY VIGLIOTTI NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2627 HYLAN BLVD. SUITE C, LOWER LEVEL
STATEN ISLAND NY
10306
US

IV. Provider business mailing address

2627 HYLAN BLVD. SUITE C, LOWER LEVEL
STATEN ISLAND NY
10306
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-1136
  • Fax: 718-667-9711
Mailing address:
  • Phone: 718-351-1136
  • Fax: 718-667-9711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number356361
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: