Provider Demographics
NPI:1801187067
Name:VICAF. INCORPORATED
Entity Type:Organization
Organization Name:VICAF. INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GBENGA
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:FALANA
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,CSST
Authorized Official - Phone:718-414-4588
Mailing Address - Street 1:915 LYNN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-1221
Mailing Address - Country:US
Mailing Address - Phone:718-414-4588
Mailing Address - Fax:
Practice Address - Street 1:915 LYNN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:718-414-4588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013411-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency