Healthcare Provider Details

I. General information

NPI: 1497082317
Provider Name (Legal Business Name): VSH WELLNESS & DIAGNOSTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2009
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 57TH ST STE 1
WEST NEW YORK NJ
07093-2119
US

IV. Provider business mailing address

435 57TH ST STE 1
WEST NEW YORK NJ
07093-2119
US

V. Phone/Fax

Practice location:
  • Phone: 201-223-0202
  • Fax:
Mailing address:
  • Phone: 201-223-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA06617900
License Number StateNJ

VIII. Authorized Official

Name: DR. EMILE I RANGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 201-223-0202