Healthcare Provider Details

I. General information

NPI: 1972413987
Provider Name (Legal Business Name): VIA VITA MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SAINT GEORGES AVE STE 200B
AVENEL NJ
07001-1390
US

IV. Provider business mailing address

1030 SAINT GEORGES AVE STE 200B
AVENEL NJ
07001-1390
US

V. Phone/Fax

Practice location:
  • Phone: 908-202-9198
  • Fax:
Mailing address:
  • Phone: 908-908-5864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BISHOY HANNA
Title or Position: MANAGING MEMBER
Credential: MD
Phone: 908-202-9198