Healthcare Provider Details

I. General information

NPI: 1033922026
Provider Name (Legal Business Name): VITAL IV INFUSIONS MONTCLAIR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 CLAREMONT AVE
MONTCLAIR NJ
07042-4854
US

IV. Provider business mailing address

49 CLAREMONT AVE
MONTCLAIR NJ
07042-4854
US

V. Phone/Fax

Practice location:
  • Phone: 856-712-3505
  • Fax:
Mailing address:
  • Phone: 856-712-3505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: TEJASH SHAH
Title or Position: OWNER
Credential: CRNA
Phone: 856-712-3505