Provider Demographics
NPI:1558849604
Name:VITALE, SUZETTE MARCHAND (MPS, PT)
Entity Type:Individual
Prefix:MRS
First Name:SUZETTE
Middle Name:MARCHAND
Last Name:VITALE
Suffix:
Gender:F
Credentials:MPS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 OLD MAMARONECK RD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-3212
Mailing Address - Country:US
Mailing Address - Phone:914-437-8897
Mailing Address - Fax:
Practice Address - Street 1:185 OLD BROADWAY
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-3801
Practice Address - Country:US
Practice Address - Phone:914-478-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017573-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist