Healthcare Provider Details

I. General information

NPI: 1053243675
Provider Name (Legal Business Name): VITALITY HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 MANHATTAN AVE
BROOKLYN NY
11222-2910
US

IV. Provider business mailing address

324 NETHERLAND AVE
STATEN ISLAND NY
10303-2208
US

V. Phone/Fax

Practice location:
  • Phone: 347-219-0924
  • Fax:
Mailing address:
  • Phone: 347-219-0924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTHONIA O. LATUNJI
Title or Position: CEO
Credential: NP
Phone: 347-219-0924