1679821086 NPI number — BEYOND VTC 2020 PROFESSIONAL CORPORATION

Table of content: (NPI 1679821086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679821086 NPI number — BEYOND VTC 2020 PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEYOND VTC 2020 PROFESSIONAL CORPORATION
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:
1679821086
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
579 CRANBURY RD
Provider Second Line Business Mailing Address:
SUITE I
Provider Business Mailing Address City Name:
EAST BRUNSWICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08816-5405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-307-7933
Provider Business Mailing Address Fax Number:
732-307-7934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
579 CRANBURY RD
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
EAST BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08816-5405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-307-7933
Provider Business Practice Location Address Fax Number:
732-307-7934
Provider Enumeration Date:
08/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
KIRTI
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
732-307-7933

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com