Provider Demographics
NPI:1821005794
Name:VITAL FACTOR INC
Entity Type:Organization
Organization Name:VITAL FACTOR INC
Other - Org Name:WESTBURY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMCIST/ PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:FUSARO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:516-333-1019
Mailing Address - Street 1:247-3 POST AVE.
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590
Mailing Address - Country:US
Mailing Address - Phone:516-333-1019
Mailing Address - Fax:516-333-2279
Practice Address - Street 1:247-3 POST AVE.
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590
Practice Address - Country:US
Practice Address - Phone:516-333-1019
Practice Address - Fax:516-333-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0247353336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02655847Medicaid
NY4471200001Medicare NSC