Provider Demographics
NPI:1629039896
Name:VITALE, VALERIE J (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:J
Last Name:VITALE
Suffix:
Gender:F
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:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:VT
Mailing Address - Zip Code:05774-0778
Mailing Address - Country:US
Mailing Address - Phone:860-597-1525
Mailing Address - Fax:
Practice Address - Street 1:35 E 38TH ST APT 10G
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2524
Practice Address - Country:US
Practice Address - Phone:860-597-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177739-01207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT033390OtherCONNECTICARE
CT497720OtherAETNA US HEALTHCARE
CTOR2818OtherHEALTHNET
CT0271873004OtherCIGNA
CTHAS 077OtherOXFORD
CT010033390CT01OtherANTHEM BC/BS
CTOR2818OtherHEALTHNET