Healthcare Provider Details

I. General information

NPI: 1861797789
Provider Name (Legal Business Name): CARL A. VITOLA, DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 ROUTE 168 SUITE C3
TURNERSVILLE NJ
08012-3233
US

IV. Provider business mailing address

900 ROUTE 168 SUITE C3
TURNERSVILLE NJ
08012-3233
US

V. Phone/Fax

Practice location:
  • Phone: 856-374-0430
  • Fax: 856-374-0048
Mailing address:
  • Phone: 856-374-0430
  • Fax: 856-374-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMB36306
License Number StateNJ

VIII. Authorized Official

Name: DR. CARL A VITOLA
Title or Position: DOCTOR
Credential: DO
Phone: 856-374-0430