1609829985 NPI number — DR. JOHN VITALI MD

Table of content: DR. JOHN VITALI MD (NPI 1609829985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609829985 NPI number — DR. JOHN VITALI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VITALI
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609829985
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 BEAVER DAM RD STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POINT PLEASANT BORO
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08742-4970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-503-4469
Provider Business Mailing Address Fax Number:
848-224-4503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2130 HIGHWAY 35
Provider Second Line Business Practice Location Address:
SUITE 324
Provider Business Practice Location Address City Name:
SEA GIRT
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08750-1010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-974-1980
Provider Business Practice Location Address Fax Number:
732-974-2117
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA058140 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1055691 . This is a "HORIZON NJ HEALTH SEA GIR" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4249471 . This is a "AETNA PPO SEA GIRT LOCATI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 431884 . This is a "PHCS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1029602 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0295568000 . This is a "AMERIHEALTH NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2591715 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K5495 . This is a "HEALTHNET OF THE NORTHEAS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: MP107 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P00126198 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5453402 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 763621 . This is a "FIRST HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5067041 . This is a "CCN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0531223 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1040679 . This is a "HORIZON NJ HEALTH HOWELL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 140037 . This is a "AETNA HMO SEA GIRT LOCATI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 13311 . This is a "AETNA HMO HOWELL LOCATION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4249471 . This is a "AETNA PPO HOWELL LOCATION" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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