MEDICARE: JOHN VITOLO, M.D. P.C.

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	174400000X	Specialist	MA46935	NJ

General Provider Information

NPI Number	:	1437349644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN VITOLO, M.D. P.C.

Provider Business Mailing Address
First Line	:	540 LAFAYETTE RD
Second Line	:	SUITE D
City	:	SPARTA
State	:	NJ
Zip	:	07871-3447
Country	:	US
Telephone Number	:	973-300-1553
Fax Number	:

Provider Business Practice Location Address
First Line	:	540 LAFAYETTE RD
Second Line	:	SUITE D
City	:	SPARTA
State	:	NJ
Zip	:	07871-3447
Country	:	US
Telephone Number	:	973-300-1553
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JOHN VITOLO
Credential	:	M.D.
Telephone Number	:	973-300-1553

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	12/31/2007

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