Provider Demographics
NPI:1225306350
Name:VIT RETINA LLC
Entity Type:Organization
Organization Name:VIT RETINA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHIRAG
Authorized Official - Middle Name:V
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-617-0473
Mailing Address - Street 1:7 BOG AND VLY LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07035-1346
Mailing Address - Country:US
Mailing Address - Phone:973-617-0473
Mailing Address - Fax:
Practice Address - Street 1:7 BOG AND VLY LN
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:NJ
Practice Address - Zip Code:07035-1346
Practice Address - Country:US
Practice Address - Phone:973-617-0473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-03
Last Update Date:2011-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08820200207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205940392OtherINDIVIDUAL NPI
1205940392OtherINDIVIDUAL NPI