Provider Demographics
NPI:1588621007
Name:VITALE, CARL (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:VITALE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GALLOPING HILL RD
Mailing Address - Street 2:STE 107
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7989
Mailing Address - Country:US
Mailing Address - Phone:908-964-7333
Mailing Address - Fax:908-687-7855
Practice Address - Street 1:1000 GALLOPING HILL RD
Practice Address - Street 2:STE 107
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7989
Practice Address - Country:US
Practice Address - Phone:908-964-7333
Practice Address - Fax:908-687-7855
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA39610207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3343600Medicaid
NJ205641CP5OtherMEDICARE ID-TYPE UNSPECIFIED
NJ3343600Medicaid
C56649Medicare UPIN