MEDICARE: DR. NICK J VITTORIA D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	039394	NY

General Provider Information

NPI Number	:	1053301762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICK J VITTORIA D.M.D.

Provider Business Mailing Address
First Line	:	36 ELDERWOOD DR
Second Line	:
City	:	ST JAMES
State	:	NY
Zip	:	11780-3433
Country	:	US
Telephone Number	:	631-862-2260
Fax Number	:

Provider Business Practice Location Address
First Line	:	859 CONNETQUOT AVE
Second Line	:	SUITE 1
City	:	ISLIP TERRACE
State	:	NY
Zip	:	11752-1400
Country	:	US
Telephone Number	:	631-277-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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