Healthcare Provider Details

I. General information

NPI: 1265897888
Provider Name (Legal Business Name): VAST ARRAY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2015
Last Update Date: 12/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BENNETT BLVD SUITE 8
LAKEWOOD NJ
08701-5944
US

IV. Provider business mailing address

1000 BENNETT BLVD SUITE 8
LAKEWOOD NJ
08701-5944
US

V. Phone/Fax

Practice location:
  • Phone: 732-279-4939
  • Fax: 732-279-4522
Mailing address:
  • Phone: 732-279-4939
  • Fax: 732-279-4522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number StateNJ

VIII. Authorized Official

Name: MS. TERRI LEI BEIDEMAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 732-279-4939