Healthcare Provider Details

I. General information

NPI: 1588503569
Provider Name (Legal Business Name): VITALONYX MEDICAL SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

733 YONKERS AVE STE 106
YONKERS NY
10704-2659
US

IV. Provider business mailing address

733 YONKERS AVE STE 106
YONKERS NY
10704-2659
US

V. Phone/Fax

Practice location:
  • Phone: 201-641-2125
  • Fax: 212-888-6024
Mailing address:
  • Phone: 201-641-2125
  • Fax: 212-888-6024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ALTAGRACIA DE JESUS
Title or Position: OWNER
Credential:
Phone: 347-213-6894