Provider Demographics
NPI:1063056091
Name:VITALE, JEFFREY ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ANTHONY
Last Name:VITALE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:VALHALLA
Mailing Address - State:NY
Mailing Address - Zip Code:10595-1704
Mailing Address - Country:US
Mailing Address - Phone:917-471-2001
Mailing Address - Fax:
Practice Address - Street 1:28 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ARMONK
Practice Address - State:NY
Practice Address - Zip Code:10504-1824
Practice Address - Country:US
Practice Address - Phone:917-471-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-02
Last Update Date:2019-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0219862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic