Provider Demographics
NPI:1366555849
Name:ZITO, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:ZITO
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 1:69 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-3118
Mailing Address - Country:US
Mailing Address - Phone:631-446-1924
Mailing Address - Fax:631-277-0899
Practice Address - Street 1:69 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-3118
Practice Address - Country:US
Practice Address - Phone:631-446-1924
Practice Address - Fax:631-277-0899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01462317Medicaid
NYF60131Medicare UPIN