MEDICARE: THOMAS DAVID VITALE DPM

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	213ES0131X	Foot Surgery Podiatrist	003991	NY
2	213ES0103X	Foot & Ankle Surgery Podiatrist	5901400130	MI
3	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00175100	NJ

General Provider Information

NPI Number	:	1922193127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS DAVID VITALE DPM

Provider Business Mailing Address
First Line	:	160 HAMILTON AVE
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1208
Country	:	US
Telephone Number	:	201-288-2242
Fax Number	:	201-288-7372

Provider Business Practice Location Address
First Line	:	160 HAMILTON AVE
Second Line	:
City	:	HASBROUCK HEIGHTS
State	:	NJ
Zip	:	07604-1208
Country	:	US
Telephone Number	:	201-288-2242
Fax Number	:	201-288-7372

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	10/31/2019

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Directions to “ THOMAS DAVID VITALE DPM” Practice Location

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