| Vital Medical Care Aesthetics P.c. | |
|
17 W Oak St Amityville NY 11701-2960 | |
| (631) 608-1192 | |
| (631) 608-2770 |
| Full Name | Vital Medical Care Aesthetics P.c. |
|---|---|
| Speciality | Clinic/Center |
| Location | 17 W Oak St, Amityville, New York |
| Authorized Official Name and Position | Joelle Vital (OWNER) |
| Authorized Official Contact | 6316081192 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vital Medical Care Aesthetics P.c. 17 W Oak St Amityville NY 11701-2960 Ph: (631) 608-1192 | Vital Medical Care Aesthetics P.c. 17 W Oak St Amityville NY 11701-2960 Ph: (631) 608-1192 |
| NPI Number | 1942515663 |
|---|---|
| Provider Enumeration Date | 08/18/2010 |
| Last Update Date | 05/04/2015 |
| Medicare PECOS PAC ID | 4688866627 |
|---|---|
| Medicare Enrollment ID | O20101008000051 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942515663 | NPI | - | NPPES |
| 02687236 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 234089 (New York) | Primary |
| Provider Name | Joelle Vital |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013070176 PECOS PAC ID: 7113984782 Enrollment ID: I20041215000407 |
| Provider Name | Thara Foreste |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508986571 PECOS PAC ID: 6002825494 Enrollment ID: I20190307001634 |
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