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General NPI Number Information
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NPI Number | 1144708538
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Entity Type | Organization
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Legal Business Name | VIP MEDICAL GROUP OF NJ, LLC
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Dates
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Enumeration Date | 07/30/2018
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Last Update Date | 07/30/2018
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Provider Practice Location Address
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Address Line | 342 HAMBURG TPKE STE 203
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City | WAYNE
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State | NJ
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Zip | 07470-2166
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Country | US
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Telephone | 347-405-8160
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Fax | 347-405-8161
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Provider Business Mailing Address
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Address Line | 41 PARK AVE SUITE#1C
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City | NEW YORK
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State | NY
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Zip | 10016-3486
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Country | US
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Telephone | 212-518-7874
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Fax | 347-405-8161
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Authorized Official
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Title or Position | OWNER-AUTHORIZED OFFICIAL
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Name | MICHAEL NGUYEN
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Credential | MD
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Telephone | 212-518-7874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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