Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 021986 | NY |
NPI | 1063056091 |
---|---|
Provider Name | Jeffrey Anthony Vitale |
First Address | Valhalla, NY 10595-1704 |
Second Address | Armonk, NY 10504-1824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2019 |
Last Update Date | 02/11/2019 |