Healthcare Provider Details

I. General information

NPI: 1568087138
Provider Name (Legal Business Name): VITAL HEALTH MEDICAL CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2020
Last Update Date: 09/06/2023
Certification Date: 06/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 HADLEY CT
PITTSFORD NY
14534-2838
US

IV. Provider business mailing address

23 HADLEY CT
PITTSFORD NY
14534-2838
US

V. Phone/Fax

Practice location:
  • Phone: 917-365-5214
  • Fax:
Mailing address:
  • Phone: 917-365-5214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: AKM ASHFAQUR RAHMAN
Title or Position: MANAGER
Credential: MD, DO
Phone: 917-365-5214