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General NPI Number Information
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NPI Number | 1023486925
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN VASCULAR CARE LLC LIMB SALVAGE CENTER
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 1000 ROUTE 35 SOUTH SUITE 300
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-2606
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Country | US
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Telephone | 732-784-6550
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Fax | 732-737-9836
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Provider Business Mailing Address
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Address Line | 3587 HIGHWAY 9 NORTH SUITE 224
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City | FREEHOLD
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State | NJ
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Zip | 07728
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Country | US
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Telephone | 732-784-6550
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OWANO PENNYCOOKE
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Credential | MD
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Telephone | 732-784-6550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 25MA08547000
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License Number State | NJ
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