Provider Demographics
NPI:1144360215
Name:VEIN CENTER OF NORTH JERSEY, PC
Entity type:Organization
Organization Name:VEIN CENTER OF NORTH JERSEY, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:SEAVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:973-408-8346
Mailing Address - Street 1:248 COLUMBIA TURNPIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932
Mailing Address - Country:US
Mailing Address - Phone:973-408-8346
Mailing Address - Fax:973-408-8350
Practice Address - Street 1:248 COLUMBIA TURNPIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932
Practice Address - Country:US
Practice Address - Phone:973-408-8346
Practice Address - Fax:973-408-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03905400174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD06969Medicare UPIN
NJ083746Medicare PIN