Provider Demographics
NPI:1912412446
Name:NJ ENDOVASCULAR & AMPUTATION PREVENTION LLC
Entity type:Organization
Organization Name:NJ ENDOVASCULAR & AMPUTATION PREVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUNDBACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-947-6586
Mailing Address - Street 1:347 MOUNT PLEASANT AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2745
Mailing Address - Country:US
Mailing Address - Phone:973-947-6586
Mailing Address - Fax:973-947-6647
Practice Address - Street 1:347 MOUNT PLEASANT AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2745
Practice Address - Country:US
Practice Address - Phone:973-419-6315
Practice Address - Fax:973-233-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty