Healthcare Provider Details

I. General information

NPI: 1770562258
Provider Name (Legal Business Name): TERESA ERRIGO VITALE PT DPT OCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 FRANKLIN AVE STE LL2
GARDEN CITY NY
11530-1760
US

IV. Provider business mailing address

1300 FRANKLIN AVE STE LL2
GARDEN CITY NY
11530-1760
US

V. Phone/Fax

Practice location:
  • Phone: 516-663-9099
  • Fax: 516-663-9092
Mailing address:
  • Phone: 516-663-9099
  • Fax: 516-663-9092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0089441
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: