Healthcare Provider Details

I. General information

NPI: 1659187862
Provider Name (Legal Business Name): VI MEDICAL & SURGICAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2024
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9151 ESTATE THOMAS STE 104
ST THOMAS VI
00802-2711
US

IV. Provider business mailing address

PO BOX 6785
ST THOMAS VI
00804-6785
US

V. Phone/Fax

Practice location:
  • Phone: 516-972-9869
  • Fax:
Mailing address:
  • Phone: 516-972-9869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMORY DE ROULET
Title or Position: OWNER
Credential: MD MPH
Phone: 516-972-9869