Provider Demographics
NPI:1336261056
Name:BRUNETTI, VITO ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:VITO
Middle Name:ANTHONY
Last Name:BRUNETTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 WHITE PLAINS RD FL 4
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-5139
Mailing Address - Country:US
Mailing Address - Phone:914-984-2546
Mailing Address - Fax:
Practice Address - Street 1:1211 HAMBURG TPKE
Practice Address - Street 2:SUITE 205
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5043
Practice Address - Country:US
Practice Address - Phone:973-633-0808
Practice Address - Fax:973-633-8811
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243222207Y00000X
NJ25MA09215000207YX0905X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400011238Medicare PIN
NJ320126NEWMedicare PIN