NPIMap

Organization Active NPI

Vitality NP Group LLC

  • Nurse Practitioner
  • Horsham, PA
National Provider Identifier
1003453051
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
VITALITY NP GROUP LLC
Practice address
45 Loggers Mill Rd
Horsham, PA 19044-1924
Phone
(732) 282-7200
NPI assigned
Dec 9, 2019
Last updated
Feb 10, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ettie Tress
Title
Administrator
Phone
(732) 987-3855

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary
Adult Health Nurse Practitioner 363LA2200X NU
Gerontology Nurse Practitioner 363LG0600X NU

Addresses

Primary practice location

45 Loggers Mill Rd
Horsham, PA 19044-1924

Mailing address

685 River Ave Unit 3
Lakewood, NJ 08701-5288
Phone (732) 486-7373

Other practice location 1

2109 Red Lion Rd
Philadelphia, PA 19115-1711
Phone (732) 486-7373

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200210000033 PA Part B Supplier - Clinic/Group Practice 1052747128 Receives reassigned benefits from 36 practitioners
Practice locations: Horsham, PA

National Provider Directory

National Provider Directory

Locations

532 W Pittsburgh St
Greensburg, PA 15601
Phone (724) 832-4000

2109 Red Lion Rd
Philadelphia, PA 19115
Phone (215) 213-7000

1480 Oxford Valley Rd
Yardley, PA 19067
Phone (215) 321-3921

Practitioners & affiliated clinicians

Practitioners 175

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 175

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1575849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1003453051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 RIVER AVE UNIT 3",
            "city": "LAKEWOOD",
            "state": "NJ",
            "postal_code": "087015288",
            "telephone_number": "732-486-7373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 LOGGERS MILL RD",
            "city": "HORSHAM",
            "state": "PA",
            "postal_code": "190441924",
            "telephone_number": "732-282-7200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2109 Red Lion Rd",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191151711",
            "country_code": "US",
            "telephone_number": "732-486-7373",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITALITY NP GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-09",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "TRESS",
        "authorized_official_first_name": "ETTIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "732-987-3855"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Horsham, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.