Healthcare Provider Details

I. General information

NPI: 1265077739
Provider Name (Legal Business Name): VPS MEDICAL SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 STATE ROUTE 66 FL 4
NEPTUNE NJ
07753-2645
US

IV. Provider business mailing address

3600 STATE ROUTE 36 FL4
NEPTUNE NJ
07753
US

V. Phone/Fax

Practice location:
  • Phone: 732-571-1000
  • Fax:
Mailing address:
  • Phone: 732-571-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIANNE HOLLER
Title or Position: SHAREHOLDER
Credential: MD
Phone: 800-862-3330