MEDICARE: JEFFREY ANTHONY VITALE PT

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	2251X0800X	Orthopedic Physical Therapist	021986	NY

General Provider Information

NPI Number	:	1063056091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY ANTHONY VITALE PT

Provider Business Mailing Address
First Line	:	94 COLUMBUS AVE
Second Line	:
City	:	VALHALLA
State	:	NY
Zip	:	10595-1704
Country	:	US
Telephone Number	:	917-471-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	28 MAPLE AVE
Second Line	:
City	:	ARMONK
State	:	NY
Zip	:	10504-1824
Country	:	US
Telephone Number	:	917-471-2001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2019
Last Update Date	:	11/02/2019

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Directions to “ JEFFREY ANTHONY VITALE PT” Practice Location

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