Healthcare Provider Details

I. General information

NPI: 1194257048
Provider Name (Legal Business Name): NJ VEIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N WOOD AVE
LINDEN NJ
07036-4147
US

IV. Provider business mailing address

520 N WOOD AVE
LINDEN NJ
07036-4147
US

V. Phone/Fax

Practice location:
  • Phone: 908-587-9300
  • Fax: 908-587-1901
Mailing address:
  • Phone: 908-587-9300
  • Fax: 908-587-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA074505
License Number StateNJ

VIII. Authorized Official

Name: MR. PREET RANDHAWA
Title or Position: MD
Credential:
Phone: 908-587-9300