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General NPI Number Information
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NPI Number | 1891928255
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Entity Type | Individual
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Provider Name | MICHAEL VITALE MD
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Gender | Male
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 04/01/2019
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Provider Practice Location Address
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Address Line | 2800 MARCUS AVE STE 110
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City | LAKE SUCCESS
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State | NY
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Zip | 11042-1113
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Country | US
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Telephone | 516-622-7485
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Fax |
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Provider Business Mailing Address
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Address Line | 2800 MARCUS AVE STE 110
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City | LAKE SUCCESS
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State | NY
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Zip | 11042-1113
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Country | US
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Telephone | 516-622-7485
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 27742
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License Number State | NY
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