Healthcare Provider Details

I. General information

NPI: 1104512227
Provider Name (Legal Business Name): VEINS ONLY SPECIALISTS OF NEW JERSEY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 STATE ST STE 101
HACKENSACK NJ
07601-5455
US

IV. Provider business mailing address

126 STATE ST
HACKENSACK NJ
07601-5448
US

V. Phone/Fax

Practice location:
  • Phone: 973-542-2343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER ZAITSEV
Title or Position: PRESIDENT
Credential:
Phone: 973-542-2343