Vitality Wellness & Rehab LLC
Internal Medicine in Commack, NY. Organization (NPI-2).
NPI number1083173595
StatusActive
Last updated in NPPESMar 14, 2019
Details
- NPI
- 1083173595
- Entity type
- Organization (NPI-2)
- Legal business name
- Vitality Wellness & Rehab LLC
- Organization subpart
- No
- Enumeration date
- Mar 14, 2019
- Last updated
- Mar 14, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | – | – | Yes |
| 208100000X | Physical Medicine & Rehabilitation | – | – |
Practice location
66 Austin BlvdCommack, NY 11725-5733
Phone 914-376-6100
Mailing address
66 Austin BlvdCommack, NY 11725-5733
Authorized official
Melissa Nieli
Credentialing Manager
9143766100
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