Healthcare Provider Details

I. General information

NPI: 1225504327
Provider Name (Legal Business Name): VITALITY MEDICAL PARTNERS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 SUNNYSIDE BLVD STE 100
PLAINVIEW NY
11803-1539
US

IV. Provider business mailing address

131 SUNNYSIDE BLVD STE 100
PLAINVIEW NY
11803-1539
US

V. Phone/Fax

Practice location:
  • Phone: 516-243-8660
  • Fax:
Mailing address:
  • Phone: 516-243-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOELLE VITAL
Title or Position: DOCTOR
Credential: MD
Phone: 516-243-8660