Healthcare Provider Details

I. General information

NPI: 1780265447
Provider Name (Legal Business Name): VERTEX SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 DAN AND MARY ST
ELIZABETH CTY NC
27909-9085
US

IV. Provider business mailing address

1080 E GUN HILL RD
BRONX NY
10469-3742
US

V. Phone/Fax

Practice location:
  • Phone: 718-653-1117
  • Fax:
Mailing address:
  • Phone: 718-653-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. ZOYA GORNOPOLSKY
Title or Position: PRESIDENT
Credential:
Phone: 718-653-1117