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General NPI Number Information
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NPI Number | 1689808974
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Entity Type | Organization
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Legal Business Name | VASCULAR AND ENDOVASCULAR ASSOCIATES OF NJ LLC
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Dates
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Enumeration Date | 05/14/2009
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Last Update Date | 02/14/2013
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Provider Practice Location Address
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Address Line | 89 N MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3235
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Country | US
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Telephone | 201-389-3700
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Fax | 201-670-6725
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Provider Business Mailing Address
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Address Line | 89 N MAPLE AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3235
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Country | US
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Telephone | 201-389-3700
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Fax | 201-670-6725
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Authorized Official
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Title or Position | GENERAL SURGEON/VASCULAR SURGEON
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Name | DR. TAREK A ALSHAFIE
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Credential | MD
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Telephone | 201-389-3700
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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 | 25MA06880800
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License Number State | NJ
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