Provider Demographics
NPI:1841813995
Name:VPC MEDSPA 1 LLC
Entity type:Organization
Organization Name:VPC MEDSPA 1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPOLA
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:201-564-7521
Mailing Address - Street 1:26 PARK ST STE 2058
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3443
Mailing Address - Country:US
Mailing Address - Phone:201-564-7521
Mailing Address - Fax:
Practice Address - Street 1:200 CLOSTER DOCK RD FL 2
Practice Address - Street 2:
Practice Address - City:CLOSTER
Practice Address - State:NJ
Practice Address - Zip Code:07624-1928
Practice Address - Country:US
Practice Address - Phone:201-564-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty