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General NPI Number Information
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NPI Number | 1548651003
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Entity Type | Organization
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Legal Business Name | VITAL HEALTH MEDICAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 07/29/2020
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Provider Practice Location Address
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Address Line | 3730 73RD ST STE PQ
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6233
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Country | US
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Telephone | 718-247-7340
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Fax |
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Provider Business Mailing Address
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Address Line | 3730 73RD ST STE PQ
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6233
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Country | US
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Telephone | 718-247-7340
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Fax |
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Authorized Official
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Title or Position | M.D
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Name | TOWHID HOSSAIN SHIBLEE
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Credential |
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Telephone | 718-247-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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