Healthcare Provider Details

I. General information

NPI: 1750802286
Provider Name (Legal Business Name): VIP ANESTHESIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 BUTTERNUT DR
FRANKLIN LAKES NJ
07417-2281
US

IV. Provider business mailing address

719 BUTTERNUT DR
FRANKLIN LAKES NJ
07417-2281
US

V. Phone/Fax

Practice location:
  • Phone: 201-925-0277
  • Fax: 888-766-8193
Mailing address:
  • Phone: 201-925-0277
  • Fax: 888-766-8193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA08106100
License Number StateNJ

VIII. Authorized Official

Name: DR. VINCENTIU POPA
Title or Position: OWNER
Credential: MD
Phone: 201-925-0277