Healthcare Provider Details

I. General information

NPI: 1003453051
Provider Name (Legal Business Name): VITALITY NP GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2019
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LOGGERS MILL RD
HORSHAM PA
19044-1924
US

IV. Provider business mailing address

685 RIVER AVE UNIT 3
LAKEWOOD NJ
08701-5288
US

V. Phone/Fax

Practice location:
  • Phone: 732-282-7200
  • Fax:
Mailing address:
  • Phone: 732-486-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ETTIE TRESS
Title or Position: ADMINISTRATOR
Credential:
Phone: 732-987-3855