Healthcare Provider Details

I. General information

NPI: 1144360215
Provider Name (Legal Business Name): VEIN CENTER OF NORTH JERSEY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 COLUMBIA TURNPIKE SUITE 1
FLORHAM PARK NJ
07932
US

IV. Provider business mailing address

248 COLUMBIA TURNPIKE SUITE 1
FLORHAM PARK NJ
07932
US

V. Phone/Fax

Practice location:
  • Phone: 973-408-8346
  • Fax: 973-408-8350
Mailing address:
  • Phone: 973-408-8346
  • Fax: 973-408-8350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA03905400
License Number StateNJ

VIII. Authorized Official

Name: DR. PHILIP R. SEAVER JR.
Title or Position: PRESIDENT OWER
Credential: MD
Phone: 973-408-8346