Provider Demographics
NPI:1912574500
Name:VITALITY NP GROUP
Entity Type:Organization
Organization Name:VITALITY NP GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ETTIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-486-7373
Mailing Address - Street 1:685 RIVER AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5288
Mailing Address - Country:US
Mailing Address - Phone:732-486-7373
Mailing Address - Fax:
Practice Address - Street 1:6617 PEBBLE BROOKE RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3793
Practice Address - Country:US
Practice Address - Phone:732-486-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty