Healthcare Provider Details

I. General information

NPI: 1033142328
Provider Name (Legal Business Name): ADVANCED VASCULAR SOLUTIONS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 SHREWSBURY AVE SUITE 300
TINTON FALLS NJ
07724-3001
US

IV. Provider business mailing address

766 SHREWSBURY AVE SUITE 300
TINTON FALLS NJ
07724-3001
US

V. Phone/Fax

Practice location:
  • Phone: 732-345-8346
  • Fax: 732-345-8351
Mailing address:
  • Phone: 732-345-8346
  • Fax: 732-345-8351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GINA L LOUIE
Title or Position: DIRECTOR
Credential: M.D.
Phone: 732-345-8346