Provider Demographics
NPI:1114050895
Name:VITALE, JAMES (LAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:VITALE
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:326 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8703
Mailing Address - Country:US
Mailing Address - Phone:631-424-8602
Mailing Address - Fax:
Practice Address - Street 1:326 WALT WHITMAN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-8703
Practice Address - Country:US
Practice Address - Phone:631-424-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002002171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist