Healthcare Provider Details

I. General information

NPI: 1154891869
Provider Name (Legal Business Name): MRS. KATRINA VITALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 ROUTE 35
MIDDLETOWN NJ
07748-1829
US

IV. Provider business mailing address

443 MIDDLEWOOD RD
MIDDLETOWN NJ
07748-1333
US

V. Phone/Fax

Practice location:
  • Phone: 732-887-3212
  • Fax:
Mailing address:
  • Phone: 732-887-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00960600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: