Healthcare Provider Details

I. General information

NPI: 1710530340
Provider Name (Legal Business Name): THYROID VIRTUAL CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 ROUTE 9 STE 8
MANALAPAN NJ
07726-3240
US

IV. Provider business mailing address

345 ROUTE 9 STE 8
MANALAPAN NJ
07726-3240
US

V. Phone/Fax

Practice location:
  • Phone: 732-845-2200
  • Fax:
Mailing address:
  • Phone: 732-845-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IGOR PRIVEN
Title or Position: PRESIDENT
Credential: MD
Phone: 732-845-2200