Healthcare Provider Details

I. General information

NPI: 1518037068
Provider Name (Legal Business Name): GENERAL AND VASCULAR SURGICAL ASSOCIATES OF NORTH JERSEY, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 ALLWOOD RD SUITE 204
CLIFTON NJ
07012-1933
US

IV. Provider business mailing address

905 ALLWOOD RD SUITE 204
CLIFTON NJ
07012-1933
US

V. Phone/Fax

Practice location:
  • Phone: 973-778-6676
  • Fax: 973-778-2666
Mailing address:
  • Phone: 973-778-6676
  • Fax: 973-778-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH BENJAMIN BARATTA
Title or Position: OWNER
Credential:
Phone: 973-778-6676