MEDICARE: VITALITY FOR MEN, PLLC

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

General Provider Information

NPI Number	:	1437927274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALITY FOR MEN, PLLC

Provider Business Mailing Address
First Line	:	4369 SW GOSSAMER CIR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-1549
Country	:	US
Telephone Number	:	772-335-4770
Fax Number	:	772-335-4133

Provider Business Practice Location Address
First Line	:	4369 SW GOSSAMER CIR
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-1549
Country	:	US
Telephone Number	:	772-335-4770
Fax Number	:	772-335-4133

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH M WIERZBICKI
Credential	:	MD
Telephone Number	:	772-335-4770

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/12/2023

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