Healthcare Provider Details

I. General information

NPI: 1063063188
Provider Name (Legal Business Name): JVG CARDIOVASCULAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 BALDWIN RD STE 101B
PARSIPPANY NJ
07054-2901
US

IV. Provider business mailing address

197 WYCKOFF AVE
WYCKOFF NJ
07481-2548
US

V. Phone/Fax

Practice location:
  • Phone: 646-331-9154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MELISSA NIELI
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 914-376-6100