Provider Demographics
NPI:1154614378
Name:VITALE, LISA (MS, LAC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:VITALE
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S PLANK RD STE 9
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3092
Mailing Address - Country:US
Mailing Address - Phone:845-565-1688
Mailing Address - Fax:845-926-5664
Practice Address - Street 1:190 S PLANK RD STE 9
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3092
Practice Address - Country:US
Practice Address - Phone:845-565-1688
Practice Address - Fax:845-926-5664
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002463171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist