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General NPI Number Information
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NPI Number | 1114425253
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Entity Type | Organization
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Legal Business Name | PREMIER VEIN & VASCULAR, LLC
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 479 RT 520 STE A203
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City | MARLBORO
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State | NJ
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Zip | 07746
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Country | US
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Telephone | 908-812-4460
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Fax | 732-263-5029
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Provider Business Mailing Address
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Address Line | 479 COUNTY ROAD 520 STE A203
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City | MARLBORO
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State | NJ
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Zip | 07746-1087
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Country | US
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Telephone | 908-812-4460
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Fax |
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Authorized Official
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Title or Position | MD., OWNER
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Name | DR. ISAAC H. TAWFIK
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Credential | MD
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Telephone | 908-812-4460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 25MA08003200
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License Number State | NJ
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