Healthcare Provider Details

I. General information

NPI: 1467558080
Provider Name (Legal Business Name): VITAFLO USA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 N UNION ST SUITE 100
ALEXANDRIA VA
22314-2657
US

IV. Provider business mailing address

211 N UNION ST SUITE 100
ALEXANDRIA VA
22314-2657
US

V. Phone/Fax

Practice location:
  • Phone: 631-972-8985
  • Fax: 631-693-2002
Mailing address:
  • Phone: 631-972-8985
  • Fax: 631-693-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER SZYMANSKI
Title or Position: GENERAL MANAGER
Credential:
Phone: 571-527-7794