Provider Demographics
NPI:1982787792
Name:VEIN CENTER FOR WOMEN PC
Entity type:Organization
Organization Name:VEIN CENTER FOR WOMEN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GIRIJA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SURYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-290-1100
Mailing Address - Street 1:670 NORTH BEERS ST, BUILDING 2 SUITE 4
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733
Mailing Address - Country:US
Mailing Address - Phone:732-290-1100
Mailing Address - Fax:732-888-3738
Practice Address - Street 1:670 NORTH BEERS STREET
Practice Address - Street 2:BUILDING 2, SUITE 4
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1520
Practice Address - Country:US
Practice Address - Phone:732-290-1100
Practice Address - Fax:732-888-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03723200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087006Medicare ID - Type Unspecified