Healthcare Provider Details

I. General information

NPI: 1790782167
Provider Name (Legal Business Name): VIP HEALTH CARE SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 08 MYRTLE AVE
RICHMOND HILL NY
11418-1748
US

IV. Provider business mailing address

116 08 MYRTLE AVE
RICHMOND HILL NY
11418-1748
US

V. Phone/Fax

Practice location:
  • Phone: 718-849-2300
  • Fax: 718-847-4547
Mailing address:
  • Phone: 718-849-2300
  • Fax: 718-847-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1493L001
License Number StateNY

VIII. Authorized Official

Name: MRS. ZIPORAH WILON
Title or Position: CONTROLLER
Credential:
Phone: 718-847-9800