Healthcare Provider Details

I. General information

NPI: 1104115393
Provider Name (Legal Business Name): SKS VASCULAR CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 70TH ST
GUTTENBERG NJ
07093-2417
US

IV. Provider business mailing address

425 70TH ST
GUTTENBERG NJ
07093-2417
US

V. Phone/Fax

Practice location:
  • Phone: 201-854-0055
  • Fax: 201-854-2633
Mailing address:
  • Phone: 201-854-0055
  • Fax: 201-854-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA05225300
License Number StateNJ

VIII. Authorized Official

Name: DR. JOSE O SANTANA
Title or Position: SENIOR PARTNER
Credential: MD,FACC
Phone: 201-854-0055