Provider Demographics
NPI:1528746468
Name:VITRUVIAN HOLISTIC
Entity type:Organization
Organization Name:VITRUVIAN HOLISTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMONELLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-684-9346
Mailing Address - Street 1:16 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07727-1423
Mailing Address - Country:US
Mailing Address - Phone:732-684-9346
Mailing Address - Fax:
Practice Address - Street 1:1111 ARNOLD AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-2434
Practice Address - Country:US
Practice Address - Phone:732-202-7749
Practice Address - Fax:732-202-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty