Provider Demographics
NPI:1861797789
Name:CARL A. VITOLA, DO PC
Entity type:Organization
Organization Name:CARL A. VITOLA, DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:VITOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:856-374-0430
Mailing Address - Street 1:900 ROUTE 168
Mailing Address - Street 2:SUITE C3
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3233
Mailing Address - Country:US
Mailing Address - Phone:856-374-0430
Mailing Address - Fax:856-374-0048
Practice Address - Street 1:900 ROUTE 168
Practice Address - Street 2:SUITE C3
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3233
Practice Address - Country:US
Practice Address - Phone:856-374-0430
Practice Address - Fax:856-374-0048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB36306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE06142Medicare UPIN
NJ075867Medicare PIN