1285177212 NPI number — VB MEDICAL SERVICES PC

Table of content: (NPI 1285177212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285177212 NPI number — VB MEDICAL SERVICES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VB MEDICAL SERVICES PC
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:
1285177212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 204
Provider Second Line Business Mailing Address:
PLANETARIUM STATION
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10024-0204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-245-5358
Provider Business Mailing Address Fax Number:
646-219-4608

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 GREENPOINT AVE
Provider Second Line Business Practice Location Address:
SUITE 2D
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11104-1784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-362-4848
Provider Business Practice Location Address Fax Number:
646-219-4608
Provider Enumeration Date:
11/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BRANDEIS
Authorized Official First Name:
VINCENT
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PRESIDENT & MEDICAL DIRECTOR
Authorized Official Telephone Number:
646-245-5358

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G400066957 . This is a "MEDICARE MEMBER PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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