Provider Demographics
NPI:1740881382
Name:VITELLIVISCUSI, KATHLEEN (RT)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:VITELLIVISCUSI
Suffix:
Gender:F
Credentials:RT
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:VITELLI
Other - Last Name:VISCUSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RT
Mailing Address - Street 1:51 MONROE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL SPRINGS
Mailing Address - State:NJ
Mailing Address - Zip Code:08021-2756
Mailing Address - Country:US
Mailing Address - Phone:856-261-2356
Mailing Address - Fax:
Practice Address - Street 1:51 MONROE DR
Practice Address - Street 2:
Practice Address - City:LAUREL SPRINGS
Practice Address - State:NJ
Practice Address - Zip Code:08021-2756
Practice Address - Country:US
Practice Address - Phone:856-261-2356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ6043862471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography