Healthcare Provider Details

I. General information

NPI: 1639739634
Provider Name (Legal Business Name): VEIN CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2019
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 PINE ST
BRISTOL CT
06010-6948
US

IV. Provider business mailing address

101 N PLAINS INDUSTRIAL RD
WALLINGFORD CT
06492-2360
US

V. Phone/Fax

Practice location:
  • Phone: 844-868-1001
  • Fax: 860-826-1391
Mailing address:
  • Phone: 203-949-2700
  • Fax: 203-949-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY J DEE
Title or Position: PRESIDENT
Credential: MD
Phone: 203-949-2700