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General NPI Number Information
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NPI Number | 1174944482
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Entity Type | Organization
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Legal Business Name | VITALITY HEALTH MEDICAL
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Dates
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Enumeration Date | 01/04/2014
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 310 W 56TH ST SUITE 1CD
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City | NEW YORK
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State | NY
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Zip | 10019-4265
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Country | US
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Telephone | 212-245-5688
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Fax | 212-245-5677
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Provider Business Mailing Address
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Address Line | 310 W 56TH ST SUITE 1CD
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City | NEW YORK
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State | NY
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Zip | 10019-4265
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Country | US
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Telephone | 212-245-5688
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Fax | 212-245-5677
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MISS KATHERINE SANTIAGO
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Credential |
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Telephone | 212-245-5688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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