Provider Demographics
NPI:1982361432
Name:VISTAS PHYSICIAN SERVICES, LLC
Entity Type:Organization
Organization Name:VISTAS PHYSICIAN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:OYEYEMI
Authorized Official - Last Name:ADASOFUNJO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-435-1404
Mailing Address - Street 1:33 CAMERON CT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-3923
Mailing Address - Country:US
Mailing Address - Phone:708-435-1404
Mailing Address - Fax:
Practice Address - Street 1:4141 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4066
Practice Address - Country:US
Practice Address - Phone:708-435-1404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty