=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699626481
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VITAL WELLNESS GROUP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2026
-----------------------------------------------------
Last Update Date | 02/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 BROADHOLLOW RD STE 10
-----------------------------------------------------
City | MELVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11747-4920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-990-4352
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 872 MIDDLE COUNTRY RD STE 5
-----------------------------------------------------
City | SAINT JAMES
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11780-3223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-424-8602
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JAMES VITALE
-----------------------------------------------------
Credential | L.AC
-----------------------------------------------------
Telephone | 631-766-5905
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------