Provider Demographics
NPI:1629773015
Name:VPN ORTHOTICS AND MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:VPN ORTHOTICS AND MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VIKASH
Authorized Official - Middle Name:MADHUSUDAN
Authorized Official - Last Name:NEGANDHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-218-2945
Mailing Address - Street 1:2 S UNIVERSITY DR STE 325
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3307
Mailing Address - Country:US
Mailing Address - Phone:954-218-2945
Mailing Address - Fax:
Practice Address - Street 1:2 S UNIVERSITY DR STE 325
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3307
Practice Address - Country:US
Practice Address - Phone:954-218-2945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-04
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty