Individual
DR. GLENN CHARLES VITALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
385 MAIN ST, SUITE 10, WEST HAVEN, CT 06516-4312
(203) 933-8606
(203) 932-9571
Mailing address
90A BEACH AVE, MILFORD, CT 06460-8060
(203) 877-3160
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
P00345
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004060828
—
CT
Enumeration date
07/22/2005
Last updated
11/20/2009
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