Provider Demographics
NPI:1992001945
Name:VIP CARE, INC.
Entity Type:Organization
Organization Name:VIP CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDINSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:973-522-2060
Mailing Address - Street 1:60 FERRY ST STE A
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-1888
Mailing Address - Country:US
Mailing Address - Phone:973-522-2060
Mailing Address - Fax:973-522-2062
Practice Address - Street 1:60 FERRY ST STE A
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1888
Practice Address - Country:US
Practice Address - Phone:973-522-2060
Practice Address - Fax:973-522-2062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0060003251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0252310Medicaid