Provider Demographics
NPI:1407392889
Name:VIPO WAYNE NEW JERSEY, LLC
Entity Type:Organization
Organization Name:VIPO WAYNE NEW JERSEY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HALLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-405-8160
Mailing Address - Street 1:516 HAMBURG TPKE STE 5
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-2063
Mailing Address - Country:US
Mailing Address - Phone:347-405-8160
Mailing Address - Fax:347-405-8161
Practice Address - Street 1:516 HAMBURG TPKE STE 5
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2063
Practice Address - Country:US
Practice Address - Phone:347-405-8160
Practice Address - Fax:347-405-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08957700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08957700OtherNEW JERSEY LICENSE