Provider Demographics
NPI:1962926535
Name:VITAG HEALTH LLC
Entity type:Organization
Organization Name:VITAG HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:VIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKODIE
Authorized Official - Suffix:
Authorized Official - Credentials:APN
Authorized Official - Phone:800-231-2980
Mailing Address - Street 1:34 BRIGHTON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1230
Mailing Address - Country:US
Mailing Address - Phone:800-231-2980
Mailing Address - Fax:
Practice Address - Street 1:2816 MORRIS AVE STE 22
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4869
Practice Address - Country:US
Practice Address - Phone:908-829-3157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-26
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty