MEDICARE: VITALCARE MEDICAL SUPPLIES CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1720892755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VITALCARE MEDICAL SUPPLIES CORP

Provider Business Mailing Address
First Line	:	27 SKILLMAN AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5109
Country	:	US
Telephone Number	:	551-364-7031
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 SKILLMAN AVE
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07306-5109
Country	:	US
Telephone Number	:	551-364-7031
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FAIZAN KHAN
Credential	:
Telephone Number	:	551-364-7031

Provider Enumeration Date	:	01/31/2025
Last Update Date	:	01/31/2025

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