Healthcare Provider Details

I. General information

NPI: 1013524065
Provider Name (Legal Business Name): NJVEINCLINICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 BROADWAY
PATERSON NJ
07514
US

IV. Provider business mailing address

1511 SUN VALLEY WAY BLDG 15
FLORHAM PARK NJ
07932-3014
US

V. Phone/Fax

Practice location:
  • Phone: 973-437-0216
  • Fax: 973-992-1993
Mailing address:
  • Phone: 973-437-0216
  • Fax: 973-992-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HEATHER MESSIAS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 973-437-0216