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

Last updated

Jul 30, 2014By the provider in NPPES

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, MDNPI 1881645489

Title

President

Phone

(201) 569-6190

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Erica Yoon-Jung Song, M.D.

  • Obstetrics & Gynecology Physician
  • Englewood, NJ
  • NPI 1881645489
  Authorized official Same address or phone

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 (Mostly from Scratch Meals)
• Frances Vela-Cantos, NP
• Joseph Veras, CRNA
• Catherine Lynn Verhulst, MS, LCSW
• Tanya Vick
• Vicki Barnett Psy D PC
• Lillian Vidal, D.D.S.
• Arundhati Hrishikesh Vinod
• Anthony Violante Jr., A.S,B.A

• 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.