Individual
ELLEN VITIEVSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5600 KENNEDY BLVD W, SUITE 102, WEST NEW YORK, NJ 07093-1256
(201) 866-3100
(201) 866-0321
Mailing address
PO BOX 7664, NORTH BRUNSWICK, NJ 08902-7664
(201) 866-3100
(201) 866-0321
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA07786200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0076937
—
NJ
Enumeration date
09/14/2006
Last updated
02/16/2025
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