1144024001 NPI number — VITAL FOCUS THERAPY, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144024001 NPI number — VITAL FOCUS THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL FOCUS THERAPY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144024001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
REGISTERED AGENTS INC
Provider Second Line Business Mailing Address:
971 US HIGHWAY 202N STE R
Provider Business Mailing Address City Name:
BRANCHBURG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08876
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
856-283-0186
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
452 N BROADWAY APT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLOUCESTER CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08030-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-283-0186
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2025

Additional Information

Authorized Official

Authorized Official Last Name:
GRECO
Authorized Official First Name:
KRISTINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER, LCSW
Authorized Official Telephone Number:
856-283-0186

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1427710201 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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