Provider Demographics
NPI:1437246618
Name:VITALE, DONNA M (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:M
Last Name:VITALE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2456 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11245-0001
Mailing Address - Country:US
Mailing Address - Phone:718-648-8409
Mailing Address - Fax:718-648-4995
Practice Address - Street 1:2456 E 14TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11245-0001
Practice Address - Country:US
Practice Address - Phone:718-648-8409
Practice Address - Fax:718-648-4995
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006561-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006561-7OtherWORKER'S COMPENSATION
NYX47411Medicare ID - Type UnspecifiedMEDICARE