MEDICARE: CARL VITALE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	MA39610	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	205641CP5	OTHER	NJ	MEDICARE ID-TYPE UNSPECIFIED

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588621007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL VITALE MD

Provider Business Mailing Address
First Line	:	1000 GALLOPING HILL RD
Second Line	:	STE 107
City	:	UNION
State	:	NJ
Zip	:	07083-7989
Country	:	US
Telephone Number	:	908-964-7333
Fax Number	:	908-687-7855

Provider Business Practice Location Address
First Line	:	1000 GALLOPING HILL RD
Second Line	:	STE 107
City	:	UNION
State	:	NJ
Zip	:	07083-7989
Country	:	US
Telephone Number	:	908-964-7333
Fax Number	:	908-687-7855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	10/05/2011

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Directions to “ CARL VITALE MD” Practice Location

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