Provider Demographics
NPI:1689296907
Name:VITARIS, JENNIFER LYNN (BACHELOR OF SCIENCE)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:VITARIS
Suffix:
Gender:F
Credentials:BACHELOR OF SCIENCE
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:DURMAJ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BACHELOR OF SCIENCE
Mailing Address - Street 1:156 ZITTEL ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14210-2461
Mailing Address - Country:US
Mailing Address - Phone:716-428-0321
Mailing Address - Fax:
Practice Address - Street 1:1050 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-2001
Practice Address - Country:US
Practice Address - Phone:716-710-4393
Practice Address - Fax:716-856-5614
Is Sole Proprietor?:No
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator