Healthcare Provider Details

I. General information

NPI: 1629039896
Provider Name (Legal Business Name): VALERIE J VITALE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 MONROE ST
BROOKLYN NY
11221-1104
US

IV. Provider business mailing address

PO BOX 778
WELLS VT
05774-0778
US

V. Phone/Fax

Practice location:
  • Phone: 860-597-1525
  • Fax:
Mailing address:
  • Phone: 860-597-1525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number177739-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number177739-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: