1124019641 NPI number — VITAL MOBILE CARE, INC.

Table of content: (NPI 1124019641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124019641 NPI number — VITAL MOBILE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL MOBILE CARE, INC.
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:
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:
1124019641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
402 MAIN ST STE 100-255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METUCHEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08840-1846
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-549-1333
Provider Business Mailing Address Fax Number:
732-549-2149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 OLIVER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METUCHEN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-549-1333
Provider Business Practice Location Address Fax Number:
732-549-2149
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
VILENCHIK
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
732-549-1333

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  NOT AVAILABLE , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 590009412 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: NL6204 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1018072 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1078680 . This is a "HORIZON - MERCY" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: A1537303 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5165300 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com