Provider Demographics
NPI:1174944482
Name:VITALITY HEALTH MEDICAL
Entity type:Organization
Organization Name:VITALITY HEALTH MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-245-5688
Mailing Address - Street 1:310 W 56TH ST
Mailing Address - Street 2:SUITE 1CD
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4265
Mailing Address - Country:US
Mailing Address - Phone:212-245-5688
Mailing Address - Fax:212-245-5677
Practice Address - Street 1:310 W 56TH ST
Practice Address - Street 2:SUITE 1CD
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4265
Practice Address - Country:US
Practice Address - Phone:212-245-5688
Practice Address - Fax:212-245-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty