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General NPI Number Information
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NPI Number | 1841807161
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Entity Type | Organization
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Legal Business Name | NEW JERSEY VASCULAR LLC
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 410 US HIGHWAY 46
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City | FAIRFIELD
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State | NJ
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Zip | 07004-1972
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Country | US
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Telephone | 862-210-8189
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 104
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City | EAST HANOVER
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State | NJ
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Zip | 07936-0104
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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 | BILLING AGENT
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Name | MS. DEBORAH HILDERLEY
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Credential |
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Telephone | 352-683-3855
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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 |
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License Number State |
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