Provider Demographics
NPI:1457796492
Name:VSH MEDICAL & DIAGNOSTIC CENTER, INC.
Entity Type:Organization
Organization Name:VSH MEDICAL & DIAGNOSTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILE
Authorized Official - Middle Name:I
Authorized Official - Last Name:RANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-868-8686
Mailing Address - Street 1:6804 BERGENLINE AVE
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-1826
Mailing Address - Country:US
Mailing Address - Phone:201-868-8686
Mailing Address - Fax:201-868-0086
Practice Address - Street 1:6804 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-1826
Practice Address - Country:US
Practice Address - Phone:201-868-8686
Practice Address - Fax:201-868-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA066179302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG44038Medicare UPIN
NJ150758Medicare PIN