Provider Demographics
NPI:1871642033
Name:VICEND MEDICAL EQUIPMENT SUPPIES & SERVICE
Entity Type:Organization
Organization Name:VICEND MEDICAL EQUIPMENT SUPPIES & SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:OKON
Authorized Official - Last Name:UKPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:609-909-2708
Mailing Address - Street 1:5918 MAIN STREET
Mailing Address - Street 2:SUITES 102 103
Mailing Address - City:MAYSLANDING
Mailing Address - State:NJ
Mailing Address - Zip Code:08330
Mailing Address - Country:US
Mailing Address - Phone:609-909-2708
Mailing Address - Fax:609-909-2709
Practice Address - Street 1:5918 MAIN STREET
Practice Address - Street 2:SUITES 102 103
Practice Address - City:MAYSLANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330
Practice Address - Country:US
Practice Address - Phone:609-909-2708
Practice Address - Fax:609-909-2709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0041491Medicaid
NJ0041491Medicaid