| Vitality Physicians Group Practice Pc | |
|
3125 Route 9w Suite 204 New Windsor NY 12553-6764 | |
| (914) 502-3998 | |
| (518) 708-6889 |
| Full Name | Vitality Physicians Group Practice Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3125 Route 9w, New Windsor, New York |
| Authorized Official Name and Position | Mitchell Tan Cabisudo (CEO) |
| Authorized Official Contact | 5186910732 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Physicians Group Practice Pc 3125 Route 9w Ste 204 New Windsor NY 12553-6764 Ph: (914) 502-3998 | Vitality Physicians Group Practice Pc 3125 Route 9w Suite 204 New Windsor NY 12553-6764 Ph: (914) 502-3998 |
| NPI Number | 1023317484 |
|---|---|
| Provider Enumeration Date | 03/23/2011 |
| Last Update Date | 09/26/2023 |
| Certification Date | 09/26/2023 |
| Medicare PECOS PAC ID | 4880879956 |
|---|---|
| Medicare Enrollment ID | O20200928000538 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023317484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 257905 (New York) | Primary |
| Provider Name | Mitchell T Cabisudo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801055561 PECOS PAC ID: 2365627494 Enrollment ID: I20110505000255 |
| Provider Name | Fahad Sultan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821777699 PECOS PAC ID: 5799129987 Enrollment ID: I20240215001831 |
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