Provider Demographics
NPI:1881759033
Name:VITULLI FOOT CARE, PLLC
Entity type:Organization
Organization Name:VITULLI FOOT CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:TSAI-PING
Authorized Official - Last Name:CHEN-VITULLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-616-4480
Mailing Address - Street 1:1399 ROUTE 52
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-3227
Mailing Address - Country:US
Mailing Address - Phone:845-616-4480
Mailing Address - Fax:845-230-8625
Practice Address - Street 1:1399 ROUTE 52
Practice Address - Street 2:SUITE 100
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-3227
Practice Address - Country:US
Practice Address - Phone:845-616-4480
Practice Address - Fax:845-230-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005897213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02699874Medicaid
NY02699874Medicaid