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General NPI Number Information
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NPI Number | 1669874699
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Entity Type | Organization
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Legal Business Name | BEYOND 2020 VTC PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/22/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 601 HAMILTON AVE
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City | TRENTON
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State | NJ
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Zip | 08629-1915
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Country | US
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Telephone | 732-770-9311
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Fax |
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Provider Business Mailing Address
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Address Line | 20 SPRUCE MEADOWS DR
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City | MONROE TOWNSHIP
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State | NJ
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Zip | 08831-3103
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Country | US
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Telephone | 732-770-9311
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. KIRTI PATEL
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Credential | O.D.
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Telephone | 732-770-9311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 27OA00628300
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License Number State | NJ
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