Provider Demographics
NPI:1366500530
Name:VITA MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:VITA MEDICAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-692-9631
Mailing Address - Street 1:87 BERDAN AVE STE 2B
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3210
Mailing Address - Country:US
Mailing Address - Phone:973-692-9631
Mailing Address - Fax:973-692-1112
Practice Address - Street 1:87 BERDAN AVE STE 2B
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3210
Practice Address - Country:US
Practice Address - Phone:973-692-9631
Practice Address - Fax:973-692-1112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 67715207R00000X
NJMA569452085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066210Medicare ID - Type UnspecifiedGROUP ID
NJG87237Medicare UPIN
NJ6376470001Medicare NSC
NJG63238Medicare UPIN