Healthcare Provider Details

I. General information

NPI: 1669893889
Provider Name (Legal Business Name): GENERAL VASCULAR SURGICAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2013
Last Update Date: 12/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W RED BANK AVE SUITE 203
WOODBURY NJ
08096-1630
US

IV. Provider business mailing address

17 W RED BANK AVE SUITE 203
WOODBURY NJ
08096-1630
US

V. Phone/Fax

Practice location:
  • Phone: 856-848-8242
  • Fax: 856-384-6015
Mailing address:
  • Phone: 856-848-8242
  • Fax: 856-384-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY S PILLA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 856-848-8242