Healthcare Provider Details

I. General information

NPI: 1922752450
Provider Name (Legal Business Name): PISCATAWAY ENDOVASCULAR CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WILLS WAY
PISCATAWAY NJ
08854-3770
US

IV. Provider business mailing address

182 INDUSTRIAL RD
GLEN ROCK PA
17327-8626
US

V. Phone/Fax

Practice location:
  • Phone: 732-564-6351
  • Fax: 732-564-6352
Mailing address:
  • Phone: 833-426-3636
  • Fax: 717-759-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND FIGUEROA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 833-426-3636