1619012853 NPI number — MR. VITO LUKE NOVIA LMT

Table of content: MR. VITO LUKE NOVIA LMT (NPI 1619012853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619012853 NPI number — MR. VITO LUKE NOVIA LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NOVIA
Provider First Name:
VITO
Provider Middle Name:
LUKE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619012853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1813 E BROADWAY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVIEDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32765-8597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-359-2757
Provider Business Mailing Address Fax Number:
407-359-7464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1020 LOCKWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-6027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-359-2757
Provider Business Practice Location Address Fax Number:
407-359-7464
Provider Enumeration Date:
02/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MA36301 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)