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General NPI Number Information
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NPI Number | 1932314515
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Entity Type | Organization
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Legal Business Name | BROADWAY MEDICAL P.C.
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 120 BROADWAY
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City | LYNBROOK
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State | NY
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Zip | 11563-3233
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Country | US
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Telephone | 516-599-9355
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Fax | 516-593-9355
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Provider Business Mailing Address
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Address Line | 120 BROADWAY
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City | LYNBROOK
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State | NY
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Zip | 11563-3233
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Country | US
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Telephone | 516-599-9355
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Fax | 516-593-9355
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Authorized Official
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Title or Position | OWNER
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Name | JOSEPH VITOULIS
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Credential | D.O.
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Telephone | 516-599-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X002413
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 205528
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 205528
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 017855
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License Number State | NY
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