Provider Demographics
NPI:1730166877
Name:VINITSKY, STEPHEN JOHN (ANP)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOHN
Last Name:VINITSKY
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:E FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02536-2701
Mailing Address - Country:US
Mailing Address - Phone:508-540-3828
Mailing Address - Fax:
Practice Address - Street 1:45 SCHOOL STREET
Practice Address - Street 2:BRIDGEWATER STATE COLLEGE HEALTH SERVICES
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02325-0001
Practice Address - Country:US
Practice Address - Phone:508-531-2856
Practice Address - Fax:508-531-6193
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA176937363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health