MEDICARE: VITAL MEDICAL CARE 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	174400000X	Specialist

General Provider Information

NPI Number	:	1780744300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITAL MEDICAL CARE PLLC

Provider Business Mailing Address
First Line	:	444 ELMONT RD
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-3529
Country	:	US
Telephone Number	:	516-488-3552
Fax Number	:

Provider Business Practice Location Address
First Line	:	444 ELMONT RD
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-3529
Country	:	US
Telephone Number	:	516-488-3552
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	FITZCLAUD GRANT
Credential	:	MD
Telephone Number	:	516-488-3552

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/03/2013

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Directions to “VITAL MEDICAL CARE PLLC ” Practice Location

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