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General NPI Number Information
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NPI Number | 1871063867
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Entity Type | Organization
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Legal Business Name | VIP MEDICAL WELLNESS LLC
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Dates
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Enumeration Date | 12/03/2018
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Last Update Date | 12/03/2018
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Provider Practice Location Address
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Address Line | 123 BROOKVIEW DR
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City | WOODCLIFF LK
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State | NJ
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Zip | 07677-8259
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Country | US
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Telephone | 201-522-3205
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Fax | 844-243-8021
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Provider Business Mailing Address
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Address Line | PO BOX 103
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City | HILLSDALE
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State | NJ
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Zip | 07642-0103
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Country | US
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Telephone | 201-522-3205
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Fax | 844-243-8021
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Authorized Official
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Title or Position | PROVIDER
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Name | JOHN K ZAFARANLOO
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Credential | MD
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Telephone | 201-522-3205
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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 |
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License Number State |
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