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General NPI Number Information
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NPI Number | 1871043828
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL VEIN CLINICS LLC
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 113 SALEM TPKE STE 1
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City | NORWICH
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State | CT
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Zip | 06360-6484
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Country | US
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Telephone | 844-482-7285
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Fax |
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Provider Business Mailing Address
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Address Line | 495 HAWLEY LN STE 2A
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City | STRATFORD
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State | CT
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Zip | 06614-1514
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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 | COO
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Name | ANDREW CASTALDI
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Credential |
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Telephone | 203-956-6833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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