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General NPI Number Information
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NPI Number | 1093477218
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Entity Type | Organization
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Legal Business Name | NJ META ENDOVASCULAR GROUP LLC
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 150 AIRPORT RD STE 970
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City | LAKEWOOD
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State | NJ
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Zip | 08701-6924
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Country | US
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Telephone | 732-290-5193
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Fax | 732-831-7776
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Provider Business Mailing Address
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Address Line | 150 AIRPORT RD STE 970
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City | LAKEWOOD
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State | NJ
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Zip | 08701-6924
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | RICHARD DANIELS
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Credential |
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Telephone | 732-598-4226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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