Healthcare Provider Details

I. General information

NPI: 1760428098
Provider Name (Legal Business Name): ALFRED T VITANZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

IV. Provider business mailing address

45 READE PL
POUGHKEEPSIE NY
12601-3947
US

V. Phone/Fax

Practice location:
  • Phone: 845-483-6217
  • Fax: 845-483-6108
Mailing address:
  • Phone: 845-483-6217
  • Fax: 845-483-6108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number159106
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: