NPIMap

Organization Active NPI

Vitality Physicians Group Practice PC

  • Psychiatry Physician
  • New Windsor, NY
National Provider Identifier
1023317484
Registry record updated Sep 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
257905 Issued in NY
Legal business name
VITALITY PHYSICIANS GROUP PRACTICE PC
Practice address
3125 Route 9W
Suite 204
New Windsor, NY 12553-6764
Phone
(914) 502-3998
Fax
(518) 708-6889
NPI assigned
Mar 23, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2023

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

Authorized official

Name
Dr. Mitchell Tan CabisudoNPI 1801055561
Title
Ceo
Phone
(518) 691-0732

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0800X 257905 NY Primary

Addresses

Primary practice location

3125 Route 9W
Suite 204
New Windsor, NY 12553-6764

Mailing address

3125 Route 9W Ste 204
New Windsor, NY 12553-6764
Phone (914) 502-3998

Other practice location 1

100 S Bedford Rd Ste 340
Mount Kisco, NY 10549-3444
Phone (914) 502-3998

Other practice location 2

315 Madison Ave Rm 507
New York, NY 10017-5436
Phone (914) 502-3998

Other practice location 3

1 Pine West Plz
Albany, NY 12205-5539
Phone (518) 691-0732

Other names 1

  • Vitality Psychiatry Group Practice PC Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL www.vpgp.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200928000538 NY Part B Supplier - Clinic/Group Practice 4880879956 Receives reassigned benefits from 3 practitioners
Practice locations: Albany, NY; New Windsor, NY; New York, NY

National Provider Directory

National Provider Directory

Locations

3 Pine West Plz
Ste 204
Albany, NY 12205
Phone (518) 691-0732

4 Pine West Plz
Ste 403
Albany, NY 12205
Phone (518) 691-0732

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1300838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695686400000",
    "number": "1023317484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3125 ROUTE 9W STE 204",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "125536764",
            "telephone_number": "914-502-3998",
            "fax_number": "518-708-6889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3125 ROUTE 9W",
            "address_2": "SUITE 204",
            "city": "NEW WINDSOR",
            "state": "NY",
            "postal_code": "125536764",
            "telephone_number": "914-502-3998",
            "fax_number": "518-708-6889"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 S Bedford Rd Ste 340",
            "address_purpose": "LOCATION",
            "city": "Mount Kisco",
            "state": "NY",
            "postal_code": "105493444",
            "country_code": "US",
            "telephone_number": "914-502-3998",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "315 Madison Ave Rm 507",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100175436",
            "country_code": "US",
            "telephone_number": "914-502-3998",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Pine West Plz",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122055539",
            "country_code": "US",
            "telephone_number": "518-691-0732",
            "fax_number": "518-708-6889",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VITALITY PHYSICIANS GROUP PRACTICE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-23",
        "last_updated": "2023-09-26",
        "certification_date": "2023-09-26",
        "status": "A",
        "authorized_official_last_name": "CABISUDO",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "TAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "518-691-0732",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "257905",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.vpgp.org",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "3125 Route 9W",
            "address_2": "Suite 204",
            "city": "New Windsor",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125536764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Vitality Psychiatry Group Practice PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in New Windsor, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2023; 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.