Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 22DI01153300 | NJ |
NPI | 1134201809 |
---|---|
Provider Name | John William Vitale |
First Address | Toms River, NJ 08755-7340 |
Second Address | Toms River, NJ 08755-7340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 13/12/2007 |