Provider Demographics
NPI:1609829985
Name:VITALI, JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:VITALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1401 BEAVER DAM RD STE 2
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-4970
Mailing Address - Country:US
Mailing Address - Phone:732-503-4469
Mailing Address - Fax:848-224-4503
Practice Address - Street 1:2130 HIGHWAY 35
Practice Address - Street 2:SUITE 324
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1010
Practice Address - Country:US
Practice Address - Phone:732-974-1980
Practice Address - Fax:732-974-2117
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2020-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA058140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1055691OtherHORIZON NJ HEALTH SEA GIR
NJ4249471OtherAETNA PPO SEA GIRT LOCATI
NJ431884OtherPHCS
NJ1029602OtherUNITED HEALTHCARE
NJ0295568000OtherAMERIHEALTH NJ
NJ2591715OtherGHI
NJ2K5495OtherHEALTHNET OF THE NORTHEAS
NJMP107OtherOXFORD
NJP00126198OtherRAILROAD MEDICARE
NJ5453402Medicaid
NJ763621OtherFIRST HEALTH
NJ5067041OtherCCN
NJ0531223OtherCIGNA
NJ1040679OtherHORIZON NJ HEALTH HOWELL
NJ140037OtherAETNA HMO SEA GIRT LOCATI
NJ13311OtherAETNA HMO HOWELL LOCATION
NJ4249471OtherAETNA PPO HOWELL LOCATION
NJ2K5495OtherHEALTHNET OF THE NORTHEAS
NJF34937Medicare UPIN