Provider Demographics
NPI:1861031411
Name:VIP PLASTIC SURGERY
Entity type:Organization
Organization Name:VIP PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:RAHUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VEMULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-963-0809
Mailing Address - Street 1:107 MONMOUTH RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1021
Mailing Address - Country:US
Mailing Address - Phone:732-963-0809
Mailing Address - Fax:732-963-0814
Practice Address - Street 1:107 MONMOUTH RD STE 201
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1021
Practice Address - Country:US
Practice Address - Phone:732-963-0809
Practice Address - Fax:732-963-0814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty