Individual
ANTHONY VULTAGGIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
90 AIR PARK DR, RONKONKOMA, NY 11779-7360
(631) 580-4020
Mailing address
14 FORREST AVE, CENTEREACH, NY 11720-3639
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
833098141
NY
Other
Enumeration date
09/01/2014
Last updated
09/01/2014
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