MEDICARE: VITA OKLANDER PA-C

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	363AM0700X	Medical Physician Assistant	013243	NY

General Provider Information

NPI Number	:	1932343894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VITA OKLANDER PA-C

Provider Business Mailing Address
First Line	:	1526 E 31ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-3402
Country	:	US
Telephone Number	:	718-339-3344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4917
Country	:	US
Telephone Number	:	718-368-3333
Fax Number	:

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

Provider Enumeration Date	:	04/22/2009
Last Update Date	:	04/22/2009

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Directions to “ VITA OKLANDER PA-C” Practice Location

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