Provider Demographics
NPI:1114967213
Name:VITALE, VIRGINIA (OTR, CHT)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:VITALE
Suffix:
Gender:F
Credentials:OTR, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 RTE 23
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-5823
Mailing Address - Country:US
Mailing Address - Phone:973-686-0007
Mailing Address - Fax:973-686-0001
Practice Address - Street 1:1279 RTE 23
Practice Address - Street 2:SUITE 201
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-5823
Practice Address - Country:US
Practice Address - Phone:973-686-0007
Practice Address - Fax:973-686-0001
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR001541225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ094360Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER