Healthcare Provider Details

I. General information

NPI: 1073542114
Provider Name (Legal Business Name): JOHN J VULLO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 01/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 MONTAUK HWY
WEST ISLIP NY
11795-4407
US

IV. Provider business mailing address

556 MONTAUK HWY
WEST ISLIP NY
11795-4407
US

V. Phone/Fax

Practice location:
  • Phone: 631-321-4811
  • Fax: 631-321-4814
Mailing address:
  • Phone: 631-321-4811
  • Fax: 631-321-4814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number192427
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: