Healthcare Provider Details

I. General information

NPI: 1891377503
Provider Name (Legal Business Name): VANTAGE HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 W PALISADE AVE
ENGLEWOOD NJ
07631-2611
US

IV. Provider business mailing address

93 W PALISADE AVE
ENGLEWOOD NJ
07631-2611
US

V. Phone/Fax

Practice location:
  • Phone: 201-567-0500
  • Fax: 201-567-9335
Mailing address:
  • Phone: 201-567-0500
  • Fax: 201-567-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: BETTY TRELOAR
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 201-385-4400