Healthcare Provider Details

I. General information

NPI: 1194180315
Provider Name (Legal Business Name): USA VEIN CLINICS OF TOMS RIVER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2015
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 WAINWRIGHT DR
NORTHBROOK IL
60062-1900
US

IV. Provider business mailing address

81 ROUTE 37 W
TOMS RIVER NJ
08755-6406
US

V. Phone/Fax

Practice location:
  • Phone: 847-257-1244
  • Fax: 224-246-8042
Mailing address:
  • Phone: 847-257-1244
  • Fax: 224-246-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MELVONNE JONES
Title or Position: MANAGER
Credential:
Phone: 847-257-1244