Healthcare Provider Details

I. General information

NPI: 1154622801
Provider Name (Legal Business Name): VEIN TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2010
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W RIDGEWOOD AVE #306
PARAMUS NJ
07652-2361
US

IV. Provider business mailing address

1 W RIDGEWOOD AVE #306
PARAMUS NJ
07652-2361
US

V. Phone/Fax

Practice location:
  • Phone: 201-612-1750
  • Fax: 201-612-1760
Mailing address:
  • Phone: 201-612-1750
  • Fax: 201-612-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA03989100
License Number StateNJ

VIII. Authorized Official

Name: DEAN WASSERMAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 201-612-1750