Healthcare Provider Details

I. General information

NPI: 1457796492
Provider Name (Legal Business Name): VSH MEDICAL & DIAGNOSTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6804 BERGENLINE AVE
GUTTENBERG NJ
07093-1826
US

IV. Provider business mailing address

6804 BERGENLINE AVE
GUTTENBERG NJ
07093-1826
US

V. Phone/Fax

Practice location:
  • Phone: 201-868-8686
  • Fax: 201-868-0086
Mailing address:
  • Phone: 201-868-8686
  • Fax: 201-868-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberMA066179
License Number StateNJ

VIII. Authorized Official

Name: DR. EMILE I RANGEL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 201-868-8686