Healthcare Provider Details

I. General information

NPI: 1710329362
Provider Name (Legal Business Name): VI MEDICAL P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 07/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

561 EAST 3RD STREET
BLKLYN NY
11218
US

IV. Provider business mailing address

561 EAST 3RD STREET
BLKLYN NY
11218
US

V. Phone/Fax

Practice location:
  • Phone: 718-438-0303
  • Fax: 718-438-0486
Mailing address:
  • Phone: 718-438-0303
  • Fax: 718-438-0486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number218120
License Number StateNY

VIII. Authorized Official

Name: MR. SIMON GREGORY URMAN
Title or Position: PRESIDENT
Credential:
Phone: 718-438-0303