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Organization
VAULT MEDICAL GROUP PA
Active
Organization
VAULT MEDICAL GROUP PA
Active
Other names
Vault Medical Services PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER WOJCIECH PASTUSZAK MD (CHIEF CLINICAL OFFICER)
(415) 412-2934
Entity
Organization
Contact information
Practice address
133 E 58TH ST STE 512, NEW YORK, NY 10022-1145
(212) 880-5494
Mailing address
85 5TH AVE FL 8, NEW YORK, NY 10003-3019
(212) 880-5494
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
08/31/2020
Last updated
09/18/2020
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