MEDICARE: ARTERY AND VEIN INSTITUTE, LLC

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	2086S0129X	Vascular Surgery Physician	MD427860	PA

General Provider Information

NPI Number	:	1376930552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARTERY AND VEIN INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	2583 COLD SPRING RD
Second Line	:
City	:	LANSDALE
State	:	PA
Zip	:	19446-6065
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2924 SWEDE RD
Second Line	:
City	:	EAST NORRITON
State	:	PA
Zip	:	19401-1336
Country	:	US
Telephone Number	:	484-370-8140
Fax Number	:	484-370-8135

Authorized Official
Title or Position	:	SOLE MEMBER
Name	:	JOSEPH L GRISAFI
Credential	:	M.D.
Telephone Number	:	484-744-1063

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	03/06/2016

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