Organization
VINE GATE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS FUNKE C. AJIBOYE (EXECUTIVE DIRECTOR)
(917) 497-6791
Entity
Organization
Contact information
Practice address
46 MAPLE ST, MILLBURN, NJ 07041-2017
(917) 497-6791
Mailing address
85 HOLLAND AVE APT 12L, STATEN ISLAND, NY 10303-1211
(917) 497-6791
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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