Basic Information
| Provider Information | |||||||||
| NPI: | 1386027340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VITALE | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 NEW KARNER RD | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122053882 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184521337 | ||||||||
| FaxNumber: | 5187246660 | ||||||||
| Practice Location | |||||||||
| Address1: | 258 HOOSICK ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | TROY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121802444 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5182720232 | ||||||||
| FaxNumber: | 5182724083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2015 | ||||||||
| LastUpdateDate: | 07/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 018731 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.