Provider Demographics
NPI:1043525439
Name:VITALE, DIANA RODRIGUES (MD)
Entity type:Individual
Prefix:DR
First Name:DIANA
Middle Name:RODRIGUES
Last Name:VITALE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:502 VALLEY RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3509
Mailing Address - Country:US
Mailing Address - Phone:973-696-3567
Mailing Address - Fax:973-696-1921
Practice Address - Street 1:502 VALLEY RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3509
Practice Address - Country:US
Practice Address - Phone:973-696-3567
Practice Address - Fax:973-696-1921
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA09281600207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology