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General NPI Number Information
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NPI Number | 1639570674
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Entity Type | Organization
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Legal Business Name | VIP MEDICAL CENTER, PLLC
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Dates
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Enumeration Date | 09/09/2014
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Last Update Date | 10/06/2014
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Provider Practice Location Address
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Address Line | 2500 E HALLANDALE BEACH BLVD SUITE 203
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4834
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Country | US
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Telephone | 954-501-0010
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Fax | 305-455-9676
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Provider Business Mailing Address
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Address Line | 301 174TH STREET SUITE 1714
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City | SUNNY ISLES
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State | FL
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Zip | 33160
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Country | US
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Telephone | 954-501-0010
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Fax | 305-455-9676
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Authorized Official
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Title or Position | OWNER PHYSICIAN
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Name | GENRIYETTA ROZENBLAT
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Credential | D.O.
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Telephone | 305-318-5696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | OS11798
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License Number State | FL
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