Healthcare Provider Details

I. General information

NPI: 1710504881
Provider Name (Legal Business Name): VIMAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CORNWALL CT
EAST BRUNSWICK NJ
08816-3347
US

IV. Provider business mailing address

108 GALLOPING HILL RD
COLTS NECK NJ
07722-1538
US

V. Phone/Fax

Practice location:
  • Phone: 732-955-4141
  • Fax:
Mailing address:
  • Phone: 732-616-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIKTOR DUBINSKIY
Title or Position: PRESIDENT
Credential:
Phone: 732-616-8090