Provider Demographics
NPI:1649381187
Name:VITA MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:VITA MEDICAL ASSOCIATES, PC
Other - Org Name:VITA MEDICAL ASSOCIATES PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MASENHEIIMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-866-0113
Mailing Address - Street 1:306 S NEW ST STE 201
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1112
Mailing Address - Country:US
Mailing Address - Phone:610-866-0113
Mailing Address - Fax:610-974-8589
Practice Address - Street 1:306 S NEW ST STE 201
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1652
Practice Address - Country:US
Practice Address - Phone:610-866-0113
Practice Address - Fax:610-974-8589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040218L207RG0100X
PAMD041008L207RH0003X
PASP008429363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012930600003Medicaid
PA0018028540001Medicaid
PA0014316580002Medicaid
PAQ50583Medicare UPIN
PANI039766Medicare ID - Type UnspecifiedANNA A NIEWIAROWSKA, M.D.
PA094619ZCRRMedicare PIN
PAF46914Medicare UPIN
PA4576470001Medicare NSC
PA719664ZCRRMedicare PIN
PA144950Medicare PIN
PA446915ZCRRMedicare PIN
PA0012930600003Medicaid
PA094619N8GMedicare ID - Type UnspecifiedGUIYUN ZHOU,CNP