Provider Demographics
NPI:1831386457
Name:LOUIS R VITA DDS LLC
Entity type:Organization
Organization Name:LOUIS R VITA DDS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:VITA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-777-1933
Mailing Address - Street 1:991 VAN HOUTEN AVE
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2643
Mailing Address - Country:US
Mailing Address - Phone:973-777-1933
Mailing Address - Fax:973-777-4727
Practice Address - Street 1:991 VAN HOUTEN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-2643
Practice Address - Country:US
Practice Address - Phone:973-777-1933
Practice Address - Fax:973-777-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 05517111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ051585Medicare PIN