Provider Demographics
NPI:1578223764
Name:VJWDC, INC
Entity Type:Organization
Organization Name:VJWDC, INC
Other - Org Name:EAST COAST HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-513-3954
Mailing Address - Street 1:PO BOX 935934
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5934
Mailing Address - Country:US
Mailing Address - Phone:941-209-5410
Mailing Address - Fax:941-209-5652
Practice Address - Street 1:10550 DEERWOOD PARK BLVD STE 609B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-2811
Practice Address - Country:US
Practice Address - Phone:904-513-3954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty