NPIMap

Organization Active NPI

Vitaliy Medical Aesthetics

  • Family Medicine Physician
  • Worcester, MA
National Provider Identifier
1790404713
Registry record updated Aug 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
VITALIY MEDICAL AESTHETICS
Practice address
10 Dixfield Rd
Worcester, MA 01606-1084
Phone
(857) 701-5425
Fax
(508) 373-2429
NPI assigned
Aug 23, 2022
Last updated
Aug 23, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2022

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

Authorized official

Name
Alice Wangari Waithaka, FNP-BC,RNNPI 1588392138
Title
Family Nurse Practitioner
Phone
(857) 701-5425

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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

10 Dixfield Rd
Worcester, MA 01606-1084

Mailing address

10 Dixfield Rd
Worcester, MA 01606-1084
Phone (857) 701-5425

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL KAREO Health Information Exchange (HIE)

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661212800000",
    "number": "1790404713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 DIXFIELD RD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016061084",
            "telephone_number": "857-701-5425",
            "fax_number": "508-373-2429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 DIXFIELD RD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016061084",
            "telephone_number": "857-701-5425",
            "fax_number": "508-373-2429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALIY MEDICAL AESTHETICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A",
        "authorized_official_last_name": "WAITHAKA",
        "authorized_official_first_name": "ALICE",
        "authorized_official_middle_name": "WANGARI",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER",
        "authorized_official_telephone_number": "857-701-5425",
        "authorized_official_credential": "FNP-BC,RN"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "KAREO",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "10 Dixfield Rd",
            "city": "Worcester",
            "state": "MA",
            "country_code": "US",
            "postal_code": "016061084",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.