Provider Demographics
NPI:1396201711
Name:JAMES VITALE, LICENSED ACUPUNCTURIST, P.C.
Entity Type:Organization
Organization Name:JAMES VITALE, LICENSED ACUPUNCTURIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:631-244-8602
Mailing Address - Street 1:326 WALT WHITMAN RD STE 103
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-8706
Mailing Address - Country:US
Mailing Address - Phone:631-424-8602
Mailing Address - Fax:
Practice Address - Street 1:326 WALT WHITMAN RD STE 103
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-8706
Practice Address - Country:US
Practice Address - Phone:631-424-8602
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty