Provider Demographics
NPI:1043775711
Name:NEW VITAE, INC.
Entity Type:Organization
Organization Name:NEW VITAE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROJECT MANAGEMENT
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-965-9021
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:
Mailing Address - City:LIMEPORT
Mailing Address - State:PA
Mailing Address - Zip Code:18060-0010
Mailing Address - Country:US
Mailing Address - Phone:610-965-9021
Mailing Address - Fax:610-928-0174
Practice Address - Street 1:27 S. 55TH STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-3247
Practice Address - Country:US
Practice Address - Phone:267-499-4299
Practice Address - Fax:267-713-7372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-06
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100745845Medicaid