Healthcare Provider Details

I. General information

NPI: 1710312699
Provider Name (Legal Business Name): CENTER FOR VEIN RESTORATION NJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2013
Last Update Date: 04/30/2024
Certification Date: 04/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 ESSEX ST STE 403
HACKENSACK NJ
07601-3247
US

IV. Provider business mailing address

7474 GREENWAY CENTER DRIVE SUITE 1000
GREENBELT MD
20770
US

V. Phone/Fax

Practice location:
  • Phone: 855-830-8346
  • Fax: 270-473-4321
Mailing address:
  • Phone: 240-965-3271
  • Fax: 240-473-4321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: SANJIV LAKHANPAL
Title or Position: PRESIDENT
Credential: MD
Phone: 855-830-8346