Provider Demographics
NPI:1780781484
Name:VITAGLIONE, RUTH (DC)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:VITAGLIONE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-8501
Mailing Address - Country:US
Mailing Address - Phone:631-874-5008
Mailing Address - Fax:631-874-5009
Practice Address - Street 1:22 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-8501
Practice Address - Country:US
Practice Address - Phone:631-874-5008
Practice Address - Fax:631-874-5009
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY002818111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX16031Medicare ID - Type Unspecified
NYT52214Medicare UPIN