Provider Demographics
NPI:1538610159
Name:SALVATORE F. VITALE INC
Entity type:Organization
Organization Name:SALVATORE F. VITALE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:F
Authorized Official - Last Name:VITALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-245-9223
Mailing Address - Street 1:1541 HWY 88 W.
Mailing Address - Street 2:STE. I
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3422
Mailing Address - Country:US
Mailing Address - Phone:732-458-3422
Mailing Address - Fax:
Practice Address - Street 1:2038 NEW BEDFORD RD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07762-2507
Practice Address - Country:US
Practice Address - Phone:732-245-9223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02202800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA02202800OtherNJ MEDICAL LICENSE