Provider Demographics
NPI:1568083533
Name:VYTALIZE HEALTH
Entity Type:Organization
Organization Name:VYTALIZE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / CO-FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:FARIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-286-6666
Mailing Address - Street 1:2 HUDSON PL FL 6
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-5594
Mailing Address - Country:US
Mailing Address - Phone:201-205-2628
Mailing Address - Fax:
Practice Address - Street 1:1071 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MS
Practice Address - Zip Code:39051-3601
Practice Address - Country:US
Practice Address - Phone:601-267-4562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty