Provider Demographics
NPI:1124019641
Name:VITAL MOBILE CARE, INC.
Entity Type:Organization
Organization Name:VITAL MOBILE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:VILENCHIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-549-1333
Mailing Address - Street 1:402 MAIN ST STE 100-255
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1846
Mailing Address - Country:US
Mailing Address - Phone:732-549-1333
Mailing Address - Fax:732-549-2149
Practice Address - Street 1:26 OLIVER STREET
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840
Practice Address - Country:US
Practice Address - Phone:732-549-1333
Practice Address - Fax:732-549-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNOT AVAILABLE3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ590009412OtherRAIL ROAD MEDICARE
NJNL6204OtherHEALTHNET
NJ1018072OtherAETNA
NJ1078680OtherHORIZON - MERCY
NJA1537303OtherOXFORD
NJ5165300Medicaid
NJ226566Medicare ID - Type Unspecified