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General NPI Number Information
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NPI Number | 1003431792
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Entity Type | Organization
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Legal Business Name | VITAL U LLC
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 06/09/2020
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Provider Practice Location Address
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Address Line | 8 HAMPDEN CIR
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City | SIMSBURY
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State | CT
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Zip | 06070-1265
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Country | US
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Telephone | 860-965-6280
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Fax |
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Provider Business Mailing Address
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Address Line | 8 HAMPDEN CIR
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City | SIMSBURY
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State | CT
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Zip | 06070-1265
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Country | US
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Telephone | 860-965-6280
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | LISA H COOPERMAN
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Credential | RDN
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Telephone | 860-965-6280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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