Provider Demographics
NPI:1720554348
Name:VYTALIZE HEALTH MEDICAL 2 LLC
Entity Type:Organization
Organization Name:VYTALIZE HEALTH MEDICAL 2 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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 1:2 HUDSON PL FL 6
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5594
Practice Address - Country:US
Practice Address - Phone:201-205-2628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-22
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty