Provider Demographics
NPI:1063418457
Name:VENDITTI, THOMAS (RPA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:VENDITTI
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 923
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-0923
Mailing Address - Country:US
Mailing Address - Phone:518-883-3121
Mailing Address - Fax:518-883-3280
Practice Address - Street 1:3768 ST HWY 30
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025
Practice Address - Country:US
Practice Address - Phone:518-883-3121
Practice Address - Fax:518-883-3280
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005837363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB4425Medicare ID - Type Unspecified
NYS82158Medicare UPIN