Healthcare Provider Details

I. General information

NPI: 1609289065
Provider Name (Legal Business Name): NORTH JERSEY VASCULAR CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2014
Last Update Date: 06/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 HAMBURG TPKE SUITE 207
WAYNE NJ
07470-2156
US

IV. Provider business mailing address

246 HAMBURG TPKE SUITE 207
WAYNE NJ
07470-2156
US

V. Phone/Fax

Practice location:
  • Phone: 973-653-3366
  • Fax: 973-942-3295
Mailing address:
  • Phone: 973-653-3366
  • Fax: 973-942-3295

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: DR. MANUEL MOQUETE
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 973-653-3366