Healthcare Provider Details

I. General information

NPI: 1871063867
Provider Name (Legal Business Name): VIP MEDICAL WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 BROOKVIEW DR
WOODCLIFF LK NJ
07677-8259
US

IV. Provider business mailing address

PO BOX 103
HILLSDALE NJ
07642-0103
US

V. Phone/Fax

Practice location:
  • Phone: 201-522-3205
  • Fax: 844-243-8021
Mailing address:
  • Phone: 201-522-3205
  • Fax: 844-243-8021

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: JOHN K ZAFARANLOO
Title or Position: PROVIDER
Credential: MD
Phone: 201-522-3205