Provider Demographics
NPI:1245305291
Name:VITTENGL, MORGAN JOSEPH (MD)
Entity type:Individual
Prefix:MR
First Name:MORGAN
Middle Name:JOSEPH
Last Name:VITTENGL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2554 RTE 9
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020
Mailing Address - Country:US
Mailing Address - Phone:518-899-5002
Mailing Address - Fax:518-899-5603
Practice Address - Street 1:2554 RTE 9
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-899-5002
Practice Address - Fax:518-899-5603
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY170365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB83000Medicare UPIN