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General NPI Number Information
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NPI Number | 1033168935
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Entity Type | Organization
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Legal Business Name | VIRTUAL COLONOSCOPY COMPANY LLC
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 50 FRANKLIN LN SUITE 201
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City | MANALAPAN
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State | NJ
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Zip | 07726-2773
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Country | US
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Telephone | 732-972-6996
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Fax | 732-972-8610
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Provider Business Mailing Address
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Address Line | 303 W MAIN ST
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City | FREEHOLD
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State | NJ
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Zip | 07728-4832
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Country | US
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Telephone | 732-972-6996
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Fax | 732-972-8610
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN CHARLES WEINER
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Credential | MD
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Telephone | 732-972-6996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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