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General NPI Number Information
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NPI Number | 1730457425
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Entity Type | Organization
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Legal Business Name | VITALITY MEDICAL, PC
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 350 OLD COUNTRY RD
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City | GARDEN CITY
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State | NY
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Zip | 11530-1749
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Country | US
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Telephone | 516-279-6578
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Fax |
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Provider Business Mailing Address
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Address Line | 2942 HARBOR RD
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City | MERRICK
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State | NY
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Zip | 11566-4611
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL RICHHEIMER
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Credential |
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Telephone | 516-761-9932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 174519
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License Number State | NY
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