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Contact Information

KIM A VITACCO, NP
KIM A VITACCO ANP-C
2 SHELTER HARBOR COURT
WADING RIVER, NY11792-2202
 Phone: 631-886-1668
 Fax: 631-886-1909
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Adult Health

363LA2200X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for KIM A VITACCO · (Female)

NPI # 1912908484
Status Active
Credentials NP (Nurse Practitioner)
Entity Individual
Enumeration date 08/09/2005
Last updated 07/18/2022 - About 4 years ago
Sole proprietor 1 No
Identifiers
  • NY License # F303866
Hospital affiliation(s)
  • JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON - (Acute Care)
    75 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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