Vine Beauty Supply

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

VINE BEAUTY SUPPLY

Practice address

615 Rahway Ave
Woodbridge, NJ 07095-3437

Phone

(732) 425-5778

NPI assigned

Jun 5, 2019

Organization subpart

No

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

Authorized official

Name

Shirley Purnell

Title

President

Phone

(732) 425-5778

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1559692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559692800000",
    "number": "1568020311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 RAHWAY AVE",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070953437",
            "telephone_number": "732-425-5778",
            "fax_number": "800-745-6726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 RAHWAY AVE",
            "city": "WOODBRIDGE",
            "state": "NJ",
            "postal_code": "070953437",
            "telephone_number": "732-425-5778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "616 Rahway Ave",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "NJ",
            "postal_code": "07095",
            "country_code": "US",
            "telephone_number": "732-425-5778",
            "fax_number": "800-745-6726",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "613 Rahway Ave",
            "address_purpose": "LOCATION",
            "city": "Woodbridge",
            "state": "NJ",
            "postal_code": "070953437",
            "country_code": "US",
            "telephone_number": "732-425-5778",
            "fax_number": "800-744-6726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VINE BEAUTY SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-05",
        "last_updated": "2019-06-05",
        "status": "A",
        "authorized_official_last_name": "PURNELL",
        "authorized_official_first_name": "SHIRLEY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "732-425-5778"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922270974",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Prosthetic/Orthotic Supplier in Woodbridge, NJ
• Providers in Woodbridge, NJ by specialty
• Prosthetic/Orthotic Supplier in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2019; 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.