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General NPI Number Information
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NPI Number | 1154622801
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Entity Type | Organization
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Legal Business Name | VEIN TREATMENT CENTER
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 11/11/2010
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Provider Practice Location Address
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Address Line | 1 W RIDGEWOOD AVE #306
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City | PARAMUS
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State | NJ
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Zip | 07652-2361
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Country | US
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Telephone | 201-612-1750
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Fax | 201-612-1760
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Provider Business Mailing Address
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Address Line | 1 W RIDGEWOOD AVE #306
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City | PARAMUS
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State | NJ
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Zip | 07652-2361
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Country | US
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Telephone | 201-612-1750
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Fax | 201-612-1760
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DEAN WASSERMAN
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Credential | MD
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Telephone | 201-612-1750
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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 | 25MA03989100
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License Number State | NJ
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