Organization
VITASTAT MEDICAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEN TRUONG M.D. (MANAGER)
(917) 300-8296
Entity
Organization
Contact information
Practice address
2322 BROADWAY, ASTORIA, NY 11106-4196
(917) 300-8296
(917) 300-8296
Mailing address
8738 20TH AVE, BROOKLYN, NY 11214-4802
(917) 300-8296
(917) 300-8296
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
254736
NY
Other
Enumeration date
12/04/2012
Last updated
12/04/2012
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