Provider Demographics
NPI:1699723676
Name:NEW VISION MEDICAL ADVISORY GROUP, INC.
Entity type:Organization
Organization Name:NEW VISION MEDICAL ADVISORY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:JOAQUIN
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-778-5311
Mailing Address - Street 1:PO BOX 6350
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-5350
Mailing Address - Country:US
Mailing Address - Phone:787-778-5311
Mailing Address - Fax:787-778-5302
Practice Address - Street 1:AVE. BATANCES J-23 URB. HERMANAS DAVILA
Practice Address - Street 2:BAYAMON MEDICAL MALL
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-5350
Practice Address - Country:US
Practice Address - Phone:787-778-5311
Practice Address - Fax:787-778-5302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
PR261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN
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