Provider Demographics
NPI:1821405887
Name:VITAL, IMELDA L (MD)
Entity Type:Individual
Prefix:
First Name:IMELDA
Middle Name:L
Last Name:VITAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3223 CHURCH AVE
Mailing Address - Street 2:NEW YORK AVENUE MEDICAL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4213
Mailing Address - Country:US
Mailing Address - Phone:718-693-4900
Mailing Address - Fax:718-287-8946
Practice Address - Street 1:3223 CHURCH AVE
Practice Address - Street 2:NEW YORK AVENUE MEDICAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-4213
Practice Address - Country:US
Practice Address - Phone:718-693-4900
Practice Address - Fax:718-287-8946
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY247815-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology