Provider Demographics
NPI:1861748444
Name:COMPLETE VASCULAR INC
Entity type:Organization
Organization Name:COMPLETE VASCULAR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:IMPEDUGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-658-5882
Mailing Address - Street 1:25 ROCKWOOD PL
Mailing Address - Street 2:SUITE #425
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4957
Mailing Address - Country:US
Mailing Address - Phone:201-569-1101
Mailing Address - Fax:201-567-4039
Practice Address - Street 1:25 ROCKWOOD PL
Practice Address - Street 2:SUITE #425
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4957
Practice Address - Country:US
Practice Address - Phone:201-569-1101
Practice Address - Fax:201-567-4039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA072668002086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty