Healthcare Provider Details

I. General information

NPI: 1407392889
Provider Name (Legal Business Name): VIPO WAYNE NEW JERSEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 HAMBURG TPKE STE 5
WAYNE NJ
07470-2063
US

IV. Provider business mailing address

516 HAMBURG TPKE STE 5
WAYNE NJ
07470-2063
US

V. Phone/Fax

Practice location:
  • Phone: 347-405-8160
  • Fax: 347-405-8161
Mailing address:
  • Phone: 347-405-8160
  • Fax: 347-405-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA08957700
License Number StateNJ

VIII. Authorized Official

Name: HALLAND CHEN
Title or Position: OWNER
Credential: MD
Phone: 347-405-8160