MEDICARE: NEW VITAE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043775711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VITAE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1001
Second Line	:
City	:	LIMEPORT
State	:	PA
Zip	:	18060-0010
Country	:	US
Telephone Number	:	610-965-9021
Fax Number	:	610-928-0174

Provider Business Practice Location Address
First Line	:	27 S. 55TH STREET
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19139-3247
Country	:	US
Telephone Number	:	267-499-4299
Fax Number	:	267-713-7372

Authorized Official
Title or Position	:	DIRECTOR, PROJECT MANAGEMENT
Name	:	JOAN MUTH
Credential	:
Telephone Number	:	610-965-9021

Provider Enumeration Date	:	02/06/2019
Last Update Date	:	02/07/2019

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Directions to “NEW VITAE, INC. ” Practice Location

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