MEDICARE: ADVANCED VASCULAR SOLUTIONS, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1033142328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED VASCULAR SOLUTIONS, P.A.

Provider Business Mailing Address
First Line	:	766 SHREWSBURY AVE
Second Line	:	SUITE 300
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3001
Country	:	US
Telephone Number	:	732-345-8346
Fax Number	:	732-345-8351

Provider Business Practice Location Address
First Line	:	766 SHREWSBURY AVE
Second Line	:	SUITE 300
City	:	TINTON FALLS
State	:	NJ
Zip	:	07724-3001
Country	:	US
Telephone Number	:	732-345-8346
Fax Number	:	732-345-8351

Authorized Official
Title or Position	:	DIRECTOR
Name	:	GINA L LOUIE
Credential	:	M.D.
Telephone Number	:	732-345-8346

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	04/21/2009

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