Healthcare Provider Details

I. General information

NPI: 1932220126
Provider Name (Legal Business Name): IRENE VITO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 OVERLOOK AVE APT 24B
HACKENSACK NJ
07601-2231
US

IV. Provider business mailing address

160 OVERLOOK AVE APT 24B
HACKENSACK NJ
07601-2231
US

V. Phone/Fax

Practice location:
  • Phone: 973-420-6696
  • Fax:
Mailing address:
  • Phone: 973-420-6696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number46TA09092700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00955600
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: