Provider Demographics
NPI:1265763015
Name:VITALE, ELIZABETH CHOPIN (NP)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:CHOPIN
Last Name:VITALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:C
Other - Last Name:VITALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP
Mailing Address - Street 1:626 FLATBUSH AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1058
Mailing Address - Country:US
Mailing Address - Phone:857-753-8370
Mailing Address - Fax:929-384-7750
Practice Address - Street 1:1 5TH AVE APT 1BB
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4692
Practice Address - Country:US
Practice Address - Phone:857-753-8370
Practice Address - Fax:929-384-7750
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401358363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00401358Medicaid
NY638897-01OtherTHE UNIVERSITY OF THE STATE OF NY ED DEPT OFFICE OF THE PROFESSIONS
NYF401358OtherUNIVERSITY OF THE STATE OF NY ED DEPT OFFICE OF THE PROFESSIONS
NYF401358OtherUNIVERSITY OF THE STATE OF NY ED DEPT OFFICE OF THE PROFESSIONS