Provider Demographics
NPI:1134381874
Name:VITALI, MIEKA DANUTA (MD)
Entity type:Individual
Prefix:DR
First Name:MIEKA
Middle Name:DANUTA
Last Name:VITALI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIEKA
Other - Middle Name:DANUTA
Other - Last Name:CLOSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1729 2ND AVE
Mailing Address - Street 2:APT. PHC
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3579
Mailing Address - Country:US
Mailing Address - Phone:415-378-9494
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:BOX 1620
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6500
Practice Address - Country:US
Practice Address - Phone:212-659-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY249113207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine