Healthcare Provider Details

I. General information

NPI: 1679579569
Provider Name (Legal Business Name): VIP HEALTH CARE SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 E ECKERSON RD
SPRING VALLEY NY
10977-3014
US

IV. Provider business mailing address

11612 MYRTLE AVE
RICHMOND HILL NY
11418-1748
US

V. Phone/Fax

Practice location:
  • Phone: 845-356-6500
  • Fax: 845-356-6687
Mailing address:
  • Phone: 718-847-9800
  • Fax: 718-847-9652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1493L003
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00908636
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

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