Basic Information
| Provider Information | |||||||||
| NPI: | 1174055271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VITORSKY | ||||||||
| FirstName: | OLGA | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689 | ||||||||
| Address2: | LEHIGH VALLEY HEALTH NETWORK | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 181051556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109694370 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 17TH & CHEW | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ALLENTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 18105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6109694370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2017 | ||||||||
| LastUpdateDate: | 06/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RG0100X | OT017699 | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.