Vibrant Life Medicine, P.C.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

25MA07248000 Issued in NJ

Legal business name

VIBRANT LIFE MEDICINE, P.C.

Practice address

286 Engle St
Englewood, NJ 07631-2405

Phone

(201) 569-6190

Fax

(201) 569-6940

NPI assigned

Jul 30, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Erica Yoon-Jung Song, MD

Title

President

Phone

(201) 569-6190

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406678400000",
    "number": "1053729319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "286 ENGLE ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312405",
            "telephone_number": "201-569-6190",
            "fax_number": "201-569-6940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 ENGLE ST",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076312405",
            "telephone_number": "201-569-6190",
            "fax_number": "201-569-6940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANT LIFE MEDICINE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-30",
        "last_updated": "2014-07-30",
        "status": "A",
        "authorized_official_last_name": "SONG",
        "authorized_official_first_name": "ERICA",
        "authorized_official_middle_name": "YOON-JUNG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "201-569-6190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": "NJ",
            "license": "25MA07248000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karishma D Vaswani
• VDH Worldwide LLC
• Frances Vela-Cantos, NP
• Joseph Veras, CRNA
• Catherine Lynn Verhulst, MS, LCSW
• Vicki Barnett Psy D PC
• Lillian Vidal, D.D.S.
• Arundhati Hrishikesh Vinod
• Anthony Violante Jr., A.S,B.A
• Maria Vira, APN

• General Practice Physician in Englewood, NJ
• Providers in Englewood, NJ by specialty
• General Practice Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.