Provider Demographics
NPI:1730698127
Name:VEIN AND VASCULAR DIAGNOSIS INC
Entity type:Organization
Organization Name:VEIN AND VASCULAR DIAGNOSIS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:EKITI
Authorized Official - Middle Name:
Authorized Official - Last Name:NDOBE
Authorized Official - Suffix:
Authorized Official - Credentials:RVS
Authorized Official - Phone:240-988-8808
Mailing Address - Street 1:3185 JOHN F KENNEDY BLVD # 2
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-3415
Mailing Address - Country:US
Mailing Address - Phone:240-988-8808
Mailing Address - Fax:
Practice Address - Street 1:3185 JOHN F KENNEDY BLVD # 2
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-3415
Practice Address - Country:US
Practice Address - Phone:240-988-8808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2085U0001X
2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty