Healthcare Provider Details

I. General information

NPI: 1972754679
Provider Name (Legal Business Name): VDB ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2008
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18-01 POLLITT DR SUITE 1A
FAIR LAWN NJ
07410-2813
US

IV. Provider business mailing address

18-01 POLLITT DRIVE SUITE 1A
FAIR LAWN NJ
07410-2815
US

V. Phone/Fax

Practice location:
  • Phone: 201-478-4200
  • Fax: 201-478-4201
Mailing address:
  • Phone: 201-478-4200
  • Fax: 201-478-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: VIRGILIO CARABALLO
Title or Position: PRESIDENT & CEO
Credential:
Phone: 201-478-4200