Provider Demographics
NPI:1083356307
Name:VITALITY NP GROUP LLC
Entity Type:Organization
Organization Name:VITALITY NP GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-486-7373
Mailing Address - Street 1:685 RIVER AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5288
Mailing Address - Country:US
Mailing Address - Phone:732-486-7373
Mailing Address - Fax:
Practice Address - Street 1:511 CHANTECLER AVE STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3000
Practice Address - Country:US
Practice Address - Phone:732-486-7373
Practice Address - Fax:732-282-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty