Provider Demographics
NPI:1871063867
Name:VIP MEDICAL WELLNESS LLC
Entity type:Organization
Organization Name:VIP MEDICAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZAFARANLOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-522-3205
Mailing Address - Street 1:PO BOX 103
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-0103
Mailing Address - Country:US
Mailing Address - Phone:201-522-3205
Mailing Address - Fax:844-243-8021
Practice Address - Street 1:123 BROOKVIEW DR
Practice Address - Street 2:
Practice Address - City:WOODCLIFF LK
Practice Address - State:NJ
Practice Address - Zip Code:07677-8259
Practice Address - Country:US
Practice Address - Phone:201-522-3205
Practice Address - Fax:844-243-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty