Healthcare Provider Details

I. General information

NPI: 1659894210
Provider Name (Legal Business Name): VIMAX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1749 HOOPER AVE STE 202
TOMS RIVER NJ
08753-8130
US

IV. Provider business mailing address

108 GALLOPING HILL RD
COLTS NECK NJ
07722-1538
US

V. Phone/Fax

Practice location:
  • Phone: 732-930-1020
  • Fax:
Mailing address:
  • Phone: 732-616-8090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: VIKTOR DUBINSKIY
Title or Position: PRESIDENT
Credential:
Phone: 732-616-8090