Individual
MR. NELSON VITALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
65 LAKE DR, E PATCHOGUE, NY 11772-4724
(631) 438-0077
Mailing address
65 LAKE DR, E PATCHOGUE, NY 11772-4724
(631) 438-0077
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
006314
NY
Other
Enumeration date
03/09/2023
Last updated
03/09/2023
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