Healthcare Provider Details

I. General information

NPI: 1801301635
Provider Name (Legal Business Name): VIMINIC CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 CORNAGA AVE
FAR ROCKAWAY NY
11691-4305
US

IV. Provider business mailing address

1815 CORNAGA AVE
FAR ROCKAWAY NY
11691-4305
US

V. Phone/Fax

Practice location:
  • Phone: 718-757-1640
  • Fax:
Mailing address:
  • Phone: 718-757-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. OLGA SHNEYDER
Title or Position: PRESIDENT
Credential: RN
Phone: 718-664-0065