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General NPI Number Information
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NPI Number | 1982784161
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Entity Type | Individual
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Provider Name | JOSEPH ROBERT VITOLO MD
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 48 ROUTE 25A, SUITE 308
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-265-7744
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Fax | 631-862-3617
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Provider Business Mailing Address
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Address Line | 45 HITHERBROOK ROAD
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City | HEAD OF THE HARBOR
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State | NY
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Zip | 11780
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Country | US
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Telephone | 631-265-7744
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Fax | 631-862-3617
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 167973-1
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License Number State | NY
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