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General NPI Number Information
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NPI Number | 1558702225
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Entity Type | Organization
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Legal Business Name | VITALE WOMEN'S HEALTH OBSTETRICS AND GYNECOLOGY
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Dates
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Enumeration Date | 07/10/2013
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 502 VALLEY RD SUITE 106
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City | WAYNE
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State | NJ
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Zip | 07470-3509
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Country | US
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Telephone | 973-696-3567
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Fax | 973-696-1921
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Provider Business Mailing Address
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Address Line | 502 VALLEY RD SUITE 106
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City | WAYNE
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State | NJ
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Zip | 07470-3509
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Country | US
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Telephone | 973-696-3567
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Fax | 973-696-1921
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIANA RODRIGUES VITALE
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Credential | M.D.
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Telephone | 516-680-6647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 25MA09281600
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License Number State | NJ
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