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General NPI Number Information
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NPI Number | 1740438258
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Entity Type | Organization
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Legal Business Name | AMERICAN ORTHODONTIC ASSOCIATES OF WEST ISLIP,LLC
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Dates
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Enumeration Date | 09/09/2008
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Last Update Date | 09/09/2008
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Provider Practice Location Address
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Address Line | 1145 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4909
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Country | US
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Telephone | 631-661-3025
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Fax | 631-661-2095
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Provider Business Mailing Address
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Address Line | 1145 MONTAUK HWY
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City | WEST ISLIP
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State | NY
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Zip | 11795-4909
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Country | US
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Telephone | 631-661-3025
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Fax | 631-661-2095
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH MICHAEL VITAGLIANO
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Credential | DMD
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Telephone | 631-661-3025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 046229-1
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License Number State | NY
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