Provider Demographics
NPI:1760831119
Name:VASULI INC
Entity Type:Organization
Organization Name:VASULI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ETWARU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-804-7318
Mailing Address - Street 1:325 W 45TH ST
Mailing Address - Street 2:812
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4191
Mailing Address - Country:US
Mailing Address - Phone:212-804-7318
Mailing Address - Fax:
Practice Address - Street 1:325 W 45TH ST
Practice Address - Street 2:812
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4191
Practice Address - Country:US
Practice Address - Phone:212-804-7318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder